Angiotensin-II Receptor Antagonists
These drugs (e.g. losartan, valsartan, candesartan) are similar to the ACE inhibitors except that instead of inhibiting angiotensin-converting enzyme, they block angiotensin-II to produce similar effects. This dilates blood vessels, stimulates kidney function and may also have a direct action on the brain to reduce drinking and increase urine output. At present, they are mainly used in people who develop a persistent dry cough as a troublesome side-effect of the ACE inhibitors as these particular drugs do not produce this problem.
Other Drugs
Occasionally, drugs from the above groups may not be sufficient or suitable for treating an individual case of high blood pressure. Two other drugs are sometimes used: hydralazine or methyldopa.
Hydralazine is a vasodilator that lowers blood pressure by relaxing arteries and increasing their diameter. When used to treat hypertension, it is usually combined with a beta-blocker and thiazide diuretic to stop the heart rate and cardiac output from increasing and to avoid fluid retention. It may cause a very rapid drop in blood pressure.
Methyldopa used to be the most popular drug for treating high blood pressure, and may still be taken by elderly patients who started on it many years ago. It lowers blood pressure by acting on the brain to trigger nerve actions that reduce heart output, urine production and arteriolar constriction. Methyldopa is often used together with a diuretic. It may cause a rapid fall in blood pressure, especially in the elderly.
Your doctor may also suggest taking low-dose aspirin or taking drugs to lower blood cholesterol levels if necessary.
IS ANTI-HYPERTENSIVE TREATMENT FOR LIFE?
Once drug treatment is started for high blood pressure, it is often for life. However, if you don’t have any complications from your high blood pressure and you have managed to make diet and lifestyle changes that naturally bring your blood pressure down, it may be possible to reduce your tablet dose or to withdraw it altogether. However, you should never alter your medication or stop it suddenly yourself. If your doctor decides to withdraw your treatment, this is usually done slowly in a step-wise fashion to prevent a sudden rebound hypertension. You will be followed up closely over a long period of time, as, in some cases, BP starts to creep back up again after six months, a year or more.
IF YOU SHOULD FORGET TO TAKE YOUR MEDICATION
If you do forget to take your treatment occasionally, it is unlikely that you will come to any harm. If you forget your tablets on a regular basis, however, you may run into problems.
Tips to Help You Remember to Take Your Medication
DRUGS TO LOWER HIGH BLOOD CHOLESTEROL
The best way to reduce high cholesterol is through making dietary changes and increasing the amount of exercise you take. Doctors usually recommend a low- fat diet, using olive or rapeseed oil for cooking, eating oily fish, taking fish oil supplements and garlic powder tablets.
If dietary changes have failed, your doctor may prescribe a lipid-lowering drug. This would be in instances where total blood cholesterol is above 7.8 mmol/l and is mainly in the form of harmful LDL-cholesterol.
In some cases, raised cholesterol levels are due to hereditary difficulties with fat metabolism. In these instances, one or more drugs often have to be prescribed.
Resins
Resins (e.g. cholestyramine, colestipol) work by binding to bile acids and preventing their reabsorption in the gut. This interferes with regulatory messages feeding back to the liver, so that more cholesterol is broken down into bile acids and excreted from the body. These drugs can lower LDL-cholesterol levels by up to 25 per cent on top of that achieved through dietary changes. Unfortunately, they cause triglycerides – another type of dietary fat linked to heart disease – to rise by up to 5 per cent. They are mainly used when a statin cannot be taken (see below). Side-effects include constipation and, in long-term treatment, a lack of fat-soluble vitamins A, D, E and K.
Fibrates
Fibrates (e.g. bezafibrate, ciprofibrate, clofibrate, fenofibrate, gemfibrozil) work by lowering liver synthesis of cholesterol. They reduce total cholesterol by up to 25 per cent and triglycerides by up to 50 per cent. They also have a beneficial effect on types of cholesterol in the blood, raising HDL and lowering LDL cholesterol. Unfortunately, they can trigger muscle pain (myositis), especially in patients with kidney disease. Some encourage gallstones and inflammation of the gall bladder by increasing excretion of cholesterol into the bile. Other possible side-effects include fatigue, muscle cramps, dizziness, painful extremities, hair loss, blurred vision, impotence and, rarely, inability to feel sexual pleasure.
Statins
Statins
