Medication

Medical treatment is only commenced when the blood pressure remains high, as in 25% of cases the blood pressure will settle within 3 months.

There are 5 classes of drugs that are normally used to treat hypertension:

• Beta-Blockers: A selective beta-blocker is normally chosen in a once a day dosage, this minimizes the side effects but care should be taken if there is respiratory illness. These should not be prescribed in the presence of asthma, heart failure or heart block.
• Diuretics: In diuretics the reduction in blood pressure may take several weeks after commencing the diuretics. Low doses have been found to be just as effective as high doses and are particularly beneficial to the elderly patient.
• Calcium-Antagonists: Calcium-antagonists work as vasodilators in that they reduce the tension in the vascular system. If patients have heart failure then calcium antagonists cannot be used.
• Angiotensin-Converting Enzyme Inhibitors: This class of drug inhibits an enzyme which increases the tension in the vascular system. It should not be used in the presence of narrowing of the artery to the kidney or in pregnancy.
• Alpha-Blockers: Alpha-blockers block the nerve supply to blood vessels which causes increased tone.

The goal of treatment is to keep to top number below 140 and the bottom number below 90. In people with diabetes, the goal is to keep the top number below 130 and the bottom number below 85. In people with heart disease or kidney disease, the goal is to get the blood pressure as low as can be tolerated.

What are the side effects of the treatments?

The side effects of treatment of high blood pressure vary according to the drugs used. Beta-blockers can worsen asthma. Diuretics may cause a loss of too much fluid and minerals. Calcium channel blockers can cause swelling of the legs called edema. Angiotensin-converting enzyme inhibitors may lead to chronic dry cough. Overall, most high blood pressure medicines are well tolerated. Side effects should be discussed with the healthcare provider.