The medical term for high blood pressure is hypertension, and people that have diseases related to high blood pressure are referred to as having Hypertensive Cardiovascular Disease or HTCVD. When Doctors use the term hypertension they are not referring to patients under high emotional stress, often a point of confusion to the lay public. The primary issue in treating the patient with HTVCD is finding the right medication or combination of medications that will bring the blood pressure (BP) into the normal range without causing excessive side effects. The normal range is now designated as a blood pressure below 130/85. Blood pressure in the range of 130-139/85-89 is now considered to be high normal and this represents a change from 140/90 as being the normal range.

Different patients respond differently to the same medication, forcing the Dr. to constantly monitor the BP and adjust, alter or discontinue the medication based on the BP control and side effects produced. A good deal of trial and error is involved.
As a result the patient may have a number of medication in the medicine cabinet that have been tried and discarded. Doctors offices often have samples of various BP medications, given them by drug representatives, and are often used as "starter" prescriptions to determine patient tolerance of the medication and the effectiveness in bringing the BP down. Using samples in this manner avoids the expense of a prescription. The patient needs to understand the problems involved here and be prepared for alterations in the medications as the Dr. makes adjustments based on the side effects and control of the BP.

The primary reason to bring high blood pressure into the normal range is to avoid a stroke caused by rupture of blood vessels in the brain or a blood clot occluding one of the brain arteries.
A stroke refers to brain damage and is often associated with weakness or paralysis of one side of the body and difficulty in speaking. A stroke is a medical catastrophe because we do not have full control of our faculties and can result in severe disability. Death is one thing, but severe disability is another, meaning that we should elevate BP control to top priority and do everything possible to avoid a stroke. There is no doubt whatsoever that control of BP prevents stroke. Therefore, the patient should be prepared to make frequent visits to the Doctor and be prepared for changes in medications. The patient should not stop medications without contacting the Doctor or a medical person.

Patients should become familiar with the different classes of blood pressure medications and their potential side effects.
I will list the common blood pressure medications, but further information can be obtained from one of the medical sites on the internet or the Physicians Desk Reference (PDR) available at most book stores.

Diuretics: Diuresis means these drugs cause increased amounts of urine, thereby lowering the amount of fluid in the blood stream and in this way lowering the blood pressure. Lowering the amount of fluid in the blood stream results in less pressure on the artery wall. In general these drugs have very low side effects and are well tolerated by most patients, and the cost is low.
A potassium supplement is often required because the excessive urine output carries the blood potassium out with it and must be replenished. The other potential side effect is an increase in blood uric acid and this is often associated with Gout.

The list of diuretic drugs includes: Diuril or hydrodiuril, Lasix (furosemide), Dyazide, Maxide, Moduretic, Demadex, Edecrin, Indapamide, Microzide, Mykrox, Renese and Zaroxylin

Beta-Blockers: Beta Blockers are drugs that block the effects of adrenalin, a powerful stimulant, in the body. Beta Blockers are often well tolerated and also are quite effective, but the major complaint is tiredness or fatigue or "the wind has been taken out of my sails." These drugs are often prepared in time-release forms, allowing them to be taken once or at the most twice daily.

These drugs are Betapace, Blockadren, Corgard, Inderal, Nadolol, Sectral, Tenormin and Toprol-XL.

Calcium Channel Blockers: The drugs block the movement of calcium into the cells of the artery wall, preventing constriction of the blood vessels and promoting dilatation of the these arteries instead. The patient may feel flushed and hot after taking a pill and/or develop a headache. These drugs are effective and are often used in combination with other high blood pressure drugs.

The list of calcium channel blockers include Adalat, Cardizem, Covera-HS, DynaCirc, Isoptin, Nimotap, NorVasc, Plendil, Procardia, Sular, Trazac, Vascar and Verelan.

"ACE" Inhibitors: These drugs are "Angiotensin Converting Enzyme" (ACE) inhibitors and their discovery and development has dramatically changed and improved the treatment of high BP.
Don't try to remember the big words here, but do remember that these drugs block the effects of an important compound that causes blood vessels to constrict. In controlling blood pressure our primary goal to is to produce dilatation or an increase in size of the small arteries in the body. These drugs are very effective in lowering BP and also have a low side effect profile. The major side effect is a cough. It has also been found that the ACE inhibitors also have favorable effects on the lining of the coronary arteries and heart muscle and tend to prevent heart attacks and improve heart muscle function.

ACE Inhibitors include: Accupril, Altace, Captopril, Aceon, Lotensin, Movik, Monopril, Prinivil, Univasc, Vasotec and Zestril.

Angiotensin-Receptor Antagonists: Drugs in this category are working on another part of the angiotensin system by actually blocking the tissue receptors affected by angiotensin. With ACE inhibitors we are blocking the production of angiotensin, but here were are blocking the site when they work. The major side effect here is the development of increased blood potassium and care must be taken to avoid this complication. This means frequent blood tests after the drug is started.

Drugs in this category are: Atacand, Avapro, Cozaar, Diovan, Micardis and Teveten.

SUMMARY: The medications in use today are much more effective than those used a mere 20 years ago. The Doctor will often use combinations of drugs to bring the BP under control. By using combinations the dose of each individual drug may be lowered and in this way reduce the side effects produced. The most important message is to always take BP medications when you have high BP.
High BP is not a condition in which you can ignore treatment or stop medications just because you feel well. Keep on working with your Doctor to find the right combination of drugs that reduces the BP and has minimum side effects.