INTRODUCTION
The choice to use medications to treat high blood pressure is based on a simple consideration: Do the benefits outweigh the risks? If so, then the doctor will recommend that you either start, increase, or change your blood pressure medications.
It can be hard to remember to take medications every day, especially when you don’t notice any immediate change in the way you feel. It is important to remember that you are doing something hard today so that you can have a better life in the future, when you don’t have strokes, heart problems, and kidney damage because you protected yourself from those problems and prevented them by taking the medication when you were well.
When used properly, each of these medications have been shown to do the following:
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Up to 60% reduction in the risk of heart failure
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Up to 40% reduction in the risk of stroke
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Up to 30% reduction in death from kidney, heart, or brain damage
These medications often work best when used in a combination of low doses. For example, many studies now suggest that it is best to be on low doses of a diuretic, ACEi or ARB, and a CCB in a three drug combination. Sometimes these medications are available in a combination tablet that includes more than one medication. Ask your doctor.
Are you convinced that the benefits outweigh the downsides of taking these medications? If not, you need to talk to your doctor.
Also go see your doctor if:
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You are experiencing side-effects that are impacting daily activities
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You are experiencing side-effects that are constant and relentless
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You are experiencing multiple side effects
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You are considering stopping a prescribed medication
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You have any questions about the medications you are taking
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You have any other health concerns
WHAT DO MY PILLS DO?
Learn about your medications.
ACE inhibitors and ARBs
What do they do?
Angiotensin converting enzyme inhibitors (ACE-i’s) and Angiotensin II Receptor Blockers (ARB’s) both act to decrease the activity of the Renin-Angiotensin-Aldosterone system (RAAS) in the body. The RAS system is responsible for maintaining high blood pressure throughout the body.
The RAS system increases the blood pressure in multiple ways. In particular, it increases the amount of salt and water retained in blood vessels and constricts the blood vessels. When this system is blocked by ACE-i’s and ARB’s, these effects are reduced and blood pressure can be decreased.
What changes will I notice?
None. If the medications are functioning without negative side effects, most people won’t notice any changes as a result of taking them. However, by decreasing blood pressure in the short term they can help to prevent serious complications later in life such as heart attack or stroke.
What are some specific examples?
ACE-i's
Examples: ramipril, captopril, lisinopril, perindopril (Coversyl); end in "-pril"
USES: Hypertension, Protecting diabetic kidneys, Heart failure or recent heart attack
SIDE EFFECTS:
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Up to 1 in 10 patients will notice a persistent cough, even though they otherwise feel well and don’t have a cold, or other reason to cough (like smoking).
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Fewer patients get angioedema (swelling in the tongue and throat which can cause problems breathing).
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Even though normal pregnancies have happened in patients using this class of medication, this drug class should not be used if you are planning to become pregnant.
What do they look like?
Ramipril, 10mg capsules. There are lots of variations and this drug and other ACE inhibitors, so don’t be alarmed if your medications don’t look identical. Original image found here.
ARB's
Examples: valsartan, losartan, candesartan; end in "-sartan"
USES: Hypertension, Protecting diabetic kidneys, Heart failure or recent heart attack
SIDE EFFECTS:
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Even though normal pregnancies have happened in patients using this class of medication, this drug class should not be used if you are planning to become pregnant.
What do they look like?
Different versions of the ARB medication valsartan. There are lots of different ARB medications, so don’t be alarmed if the medication your doctor prescribed you doesn’t exactly match the photo. Original image found here.
Beta blockers
What do they do?
They slow down your heart rate.
What changes will I notice?
You may feel more fatigued and may tire easily when you first start the medication. Please contact your doctor if it doesn’t improve in a couple weeks.
What are some specific examples?
You can recognise them by their suffix, most of them end in "-lol". There are many different types of beta-blockers, each working in a slightly different manner. We will discuss a few key examples here.
Nonselective beta blockers
Examples: propranolol, carvedilol, nadolol, sotalol, timolol, labetalol
HOW THEY WORK: They block a specific receptor, the β-adrenergic receptor, present in the muscles in the heart, kidneys, and blood vessels. They slow down the heart rate, and decrease blood pressure by decreasing a hormone called renin. They also constrict the blood vessels initially, but dilate (make bigger) the blood vessel as you continue to take the medication.
USES: These medications have many uses and some agents can be used for a specific condition while others cannot. Some examples of uses include Hypertension (high blood pressure), Chronic Stable Angina (chest pain), abnormally fast heart rhythm, headache, and prevention of acute myocardial infarction (heart attack).
SOME SIDE EFFECTS:
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Bradycardia (slow heart rate)
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Worsening of congestive heart failure
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Worsening of asthma in people using certain inhalers
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Erectile dysfunction.
β1-Selective beta blockers
Examples: atenolol, bisoprolol, metoprolol, esmolol
HOW THEY WORK: They block a specific receptor, the β-adrenergic receptor, present in the muscles in the heart, kidneys, and blood vessels. They slow down the heart rate, and decrease blood pressure by decreasing a hormone called renin. They also constrict the blood vessels initially, but dilate (make bigger) the blood vessel as you continue to take the medication.
USES: These medications have many uses and some agents can be used for a specific condition while others cannot. Some examples of uses include hypertension (high blood pressure), chronic stable angina (chest pain), abnormally fast heart rhythm, headache, and prevention of acute myocardial infarction (heart attack).
SOME SIDE EFFECTS:
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Bradycardia (slow heart rate)
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Worsening of congestive heart failure
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Erectile dysfunction.
What do they look like?
Propranolol, 20 mg. Original image found here.
Atenolol, 50 mg. Original image found here.
Metoprolol, 50 mg. Original image found here.
There are lots of different brands of beta-blockers, so don’t be alarmed if the medication your doctor prescribed you doesn’t exactly match the photo.
Calcium Channel Blockers (CCBs)
What do they do?
Calcium channel blockers prevent calcium from entering cells in the heart and blood vessels resulting in ‘vasodilation’ (a widening of blood vessels leading to decreased blood pressure), and decreased conduction (speed of electric signals) and contractility (degree of contraction) through the heart.
What changes will I notice?
None. If the medications are functioning without negative side effects, most people won’t notice any changes as a result of taking them. However, by decreasing blood pressure in the short term they can help to prevent serious complications later in life such as heart attack or stroke.
What are some specific examples?
Dihydropyridines
Examples: amlodipine, nifedipine (Adalat), isradipine, felodipine, nicardipine; end in "-ipine"
HOW THEY WORK: Dihydropyridines have their largest effect on blood vessels, resulting in vasodilation (widening of vessels) and a decrease in blood pressure.
USES: Hypertension (high blood pressure), chronic stable angina (chest pain)
SOME SIDE EFFECTS:
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Peripheral edema (swelling of limbs)
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Flushing
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Reflex tachycardia (fast heart rate).
All of these side effects tend to be related to the dose used. If you encounter any of these side-effects, and they bother you enough that you want to change your treatment, we can often get rid of them by simply lowering the dose of the medication.
Non-dihydropyridines
Examples: diltiazem, verapamil
HOW THEY WORK: Nondihydropyridines have their largest effect on the heart, resulting in slowed conduction through and contraction of the heart.
USES: cardiac arrhythmias (abnormal heart rhythms where the heart beats too fast), hypertension (high blood pressure), chronic stable angina (chest pain)
SOME SIDE EFFECTS:
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Peripheral edema (swelling of limbs)
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Bradycardia (reduced heart rate)
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Constipation
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Rash
What do they look like?
Nifedipine, 20 mg. Original image found here.
Verapamil, 120 mg. Original image found here.
Diltiazem, 90 mg. Original image found here.
There are lots of different brands of CCBs, so don’t be alarmed if the medication your doctor prescribed you doesn’t exactly match the photo.
Potassium-sparing diuretics
Examples: spironolactone (Aldactone), eplerenone
HOW THEY WORK: These diuretics cause water loss by increases sodium loss from the body. Unlike other diuretics, they prevent potassium loss, which may be very helpful for people also on pills that cause low potassium.
USES: hypertension (high blood pressure), congestive heart failure. Often added as an additional diuretic or blood pressure medication.
SOME SIDE EFFECTS:
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Dyspepsia (stomach upset)
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Hyperkalemia (high potassium)
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Spironolactone only: gynecomastia (breast enlargement), decreased libido in men
Diuretics ("water pills")
What do they do?
These help your body to shed salt and water. Changes within the cells of the kidney make them more efficient, causing increased urine volume and lowering blood pressure.
What changes will I notice?
For the first one to three weeks of using them, all diuretics increase the volume of urine. Initially, you may need to urinate more frequently, and may wake up during the night with the urge to urinate. If this has a significant impact on your life, for example if you need to be near a washroom at all times, speak to your doctor.
You can reduce this side effect by decreasing the amount of liquid you consume, and by not drinking fluid after about 6 pm in the evening. Most patients who are taking diuretics for heart, stroke and blood pressure issues should be restricting their total daily fluid intake to around 2 liters per day. Also, diuretics should be taken in the morning, unless otherwise instructed by your doctor.
What are some specific examples?
There are many different classes of diuretics, each working in a slightly different manner. We will discuss a few key examples here.
Diuretics are often combined with other blood pressure medications like ACE inhibitors or CCBs, so that you only have to take one pill. Look at your prescriptions carefully!
Loop diuretics
Examples: furosemide (Lasix)
HOW THEY WORK: Loop diuretics help the body to push water out by increasing sodium and potassium loss.
USES: hypertension (high blood pressure), congestive heart failure, kidney failure, edema (swelling of body, particularly limbs)
SOME SIDE EFFECTS:
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Hyponatremia (low sodium concentration)
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Hypokalemia (low potassium)
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Rarely, causes hearing loss
HOW TO TAKE IT: If you are taking furosemide for blood pressure control, you should usually take it twice a day. The first dose should be first thing in the day, and the second dose about mid afternoon, so that any increase in urination happens before you have to go to bed.
Thiazide and thiazide-like diuretics
Examples: hydrochlorothiazide, chlorthalidone, indapamide
HOW THEY WORK: These diuretics increases sodium and potassium loss from the body like loop diuretics. They also dilate blood vessels (vasodilation) and help the body hold on to calcium.
USES: hypertension (high blood pressure), edema (swelling of body, particularly limbs), calcium kidney stones
SOME SIDE EFFECTS:
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Hyponatremia (low sodium concentration)
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Hypokalemia (low potassium)
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Erectile dysfunction
These diuretics, especially hydrochlorothiazide, are often combined with other blood pressure medications like ACE inhibitors or CCBs, so that you only have to take one pill. Look at your prescriptions carefully!
What do they look like?
Lasix (furosemide), 40 mg. Original image found here.
Hydrochlorothiazide, 50 mg. Original image found here.
Aldactone (spironolactone), 25 mg. Original image found here.
There are lots of different brands of diuretics, so don’t be alarmed if the medication your doctor prescribed you doesn’t exactly match the photo.
Renin inhibitors
What do they do?
They lower your blood pressure by blocking the action of renin, a vasoconstrictor (an agent that makes your blood vessels become smaller).
What changes will I notice?
There is a chance that you may feel lightheaded or dizzy when you first start taking the medication. Contact your doctor if the lightheaded continues or becomes bothersome, or if you faint from the lightheadedness.
What is an example?
Example: aliskiren (Tekturna, Ralisez)
HOW THEY WORK: It blocks renin by binding to it.
USES: hypertension (high blood pressure)
SOME SIDE EFFECTS:
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Diarrhea
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Hyperkalemia (high blood potassium levels)
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Fetal morbidity and mortality (let your doctor know right away if you become pregnant)
What does it look like?
Tekturna (aliskiren), 150 and 300 mg. Original images found here.
There are lots of different brands, so don’t be alarmed if the medication your doctor prescribed you doesn’t exactly match the photo.
Last updated January 2, 2020
Page created by: Alanna Kozak, Jessica Chang, Caitlin Sullivan (Meds 2022); Claire Browne (Meds 2020)