This article looks at how health care providers choose a blood pressure medication depending on your medical history and comorbidities.

stethoscope on an EKG reading
Blood pressure

There are multiple blood pressure medications and different classes.

  • Beta blockers,
  • ACE-inhibitors,
  • Diuretics,
  • Combinations pills,
  • Alpha blockers,
  • Calcium channel blockers,
  • Angiotensin 2 receptor blockers,
  • Central agonists,
  • Renin inhibitors,
  • Aldosterone antagonists,
  • Vasodilators….

With all that around there …. What is the right medication for you?

 

Remember a medication that works for your friend, let’s call her Susan might not be.

the right medication for you.

 

You are saying the medication really works for Susan and I want a piece of that blood pressure goodness.

 

Not so fast it is not as simple as that.

multiple pills placed on table with woman choosing
woman and pills

When health care providers prescribe blood pressure medications here are some of the factors they consider:

1) Age

2) Gender

3) General overall health

4) Underlying comorbidities

5) Falls & balance

6) Blood pressure medications you have tried in the past.

7) Possible drug -drug interactions with other medications you are on.

8) Even your race: Patients with an African heritage on Lisinopril, an ACE-inhibitor, have an increased risk of angioedema compared to non-Africans and increased risk of stroke.

9) One other factor to mention are side effects.

side effects on notebook with pill vial
pills and medication side effects

Any medication has side effects, and blood pressure medications are no exception.

Partner with your health care provider to lessen side effects or even switch to a different class of medication if side effects can’t be tolerated.

 

Having said all this the most important thing you can do……..

Ok are you ready for it.

Lifestyle changes.

Yes, as I have written in numerous other articles on this website about losing weight, giving up on vices such as smoking, healthy nutritional choices and exercise.

collage of different exercises
exercise and movement

Yes, you need to move.

I am not asking you do run a marathon just move, go for a walk.

It will up your energy level and you will feel better.

Stay active at least 30 minutes a day at least 5 days a week.

Oh yes, limit the amount of alcohol you drink.

For women not more than a drink a day, men not more than 2 a day.

Here are some examples of the thinking process a health care provider will take into consideration before prescribing you a blood pressure medication.

If your provider thinks he/she  can not only treat your medical condition but another condition for example diabetes this will determine their choice of medication.

For example, your provider might have placed you on an ACE-inhibitor like Lisinopril because you are a diabetic and you are losing protein in your urine.In this way your provider is not only treating your high blood pressure but using the “feature” of Lisinopril to help with a diabetes complication.

Ace-inhibitors are also recommended after a heart attack or with congestive heart failure. But if your kidney parameters are suddenly worsening on this medication your health care provider might want to switch you to some other class of medication.

 

metoprolol prescription pad
prescription pad

Beta blockers such as Metoprolol are often used by providers after a heart attack or with congestive heart failure. They are also used if you have a very fast heart rate or an irregular heart rate called atrial fibrillation.

You might be telling your health care provider that you have chest pain related to your coronary artery disease (also referred to as angina).

Your health care provider might choose a beta blocker not only to help your chest pain, but treat your blood pressure and reduce your heart rate.

All of these have been associated with decreasing your mortality risk.

COPD patient and inhaler
COPD

However, if you also have COPD, peripheral vascular disease or glucose intolerance, beta blockers might not be the best choice as the 3 disease entities I described can be exacerbated.

Unfortunately, sometimes your health care providers hands might be tied up and they might consider that the benefits of beta blockers outweigh some potential clinical risks.

Thiazide diuretics such as HCTZ are used especially in isolated systolic hypertension in older adults as well as with patients of African descent.

The same considerations are given with calcium channel blockers such as Diltiazem.

So, as you can see when choosing a blood pressure medication it’s not as simple as ABC

Think your health and your blood pressure.

 

Sources:

https://www.cdc.gov/bloodpressure/

 

 

 

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