Combination Treatment for Hypertension
What are the classes of anti-hypertension medications?
The main blood pressure drug classes include:
- Thiazide diuretics: Diuretics remove salt and excess water (fluid) from the body.
- Angiotensin converting enzyme (ACE) inhibitors: ACE inhibitors are often used in people who have diabetes or heart disease. They help lower blood pressure by inhibiting the production of angiotensin in the body. Angiotensin is a hormone that causes blood vessels to constrict which can lead to increased blood pressure.
- Angiotensin II receptor blockers (ARBs): The ARBs block the effects of angiotensin.
- Calcium channel blockers: Calcium channel blockers help lower blood pressure, slow the pulse, and treat arrhythmias (abnormal heart rhythms). Calcium channel blockers can also be used to treat angina (chest pain) and relax the heart muscle.
- Beta-blockers: Beta-blockers slow the pulse, lower blood pressure, and reduce the work of the heart.
How will I know if the combination treatment works?
Once your blood pressure is normal, your blood pressure should be measured regularly.
Blood pressure measurements may be weekly at first. Over time, they may be taken less frequently once it stays normal.
It's a good idea to measure your blood pressure at home. This will let you know how your blood pressure varies throughout the day.
You'll need to see your doctor for blood pressure checks, too. Blood tests may be needed with some treatments.
How long do I stay on combination treatment for hypertension?
You'll need to stay on medications for a long time. After one year of normal blood pressure, your doctor may reduce your treatment.
But don't stop your medication without first talking with your doctor.
Also, never run out of medicine. Keep a supply at home. Always refill your prescriptions before they run out.
Without medication, your blood pressure may rise suddenly and cause serious problems.
What is resistant hypertension?
Resistant hypertension means blood pressure that stays high despite treatment with three different types of blood pressure medications. It's thought that about 30% of people with high blood pressure have resistant hypertension.
According to the American Heart Association, old age and obesity are two risk factors for resistant hypertension. Other studies suggest that people with resistant hypertension have associated risks factors such as diabetes, obstructive sleep apnea, enlargement of the heart chambers, and or chronic kidney disease.
In making a diagnosis, doctors have to decide if the person has true resistant hypertension or if they may not be taking their medications correctly or not adhering to treatment. These scenarios are not synonymous.
Sometimes "white coat" hypertension is mistaken for resistant hypertension. With "white coat" hypertension, the patient may have a rise in blood pressure at the doctor's office but not at home.
The doctor may recommend 24-hour blood pressure monitoring to exclude "white coat" hypertension.
Patients with resistant hypertension often have many health problems. These conditions may include diabetes, sleep apnea, kidney disease, and atherosclerotic disease. These problems often make treatment difficult.
Along with using combination treatment, people with resistant hypertension may need treatment for secondary causes of hypertension such as obstructive sleep apnea. Also, stopping alcohol may help lower resistant hypertension.