High blood pressure (hypertension) is a widespread as well as underestimated disease. To avoid complications such as heart attack, stroke or kidney damage, it is important to recognize and treat high blood pressure in a timely manner. Often, adjusting the lifestyle to a healthy diet, exercising, and abstaining from nicotine will be enough to lower blood pressure below the 140/90 mmHg threshold.
Drug therapy as a last step
A drug therapy is only necessary if the blood pressure values do not decrease despite a healthy lifestyle. Which of the many medicines is best for high blood pressure depends on many factors and must be decided individually by the doctor for each patient. We have summarized for you an overview of the various antihypertensive drugs.
Hypertension: treatment with medication
In the treatment of high blood pressure, there are five groups of drugs from which the doctor selects a suitable drug for the patient at the beginning of the treatment:
- ACE inhibitors
- AT1 receptor antagonists
- Beta blockers
- Calcium antagonists
If the selected drug does not have sufficient effect, the doctor can either change the product or combine two drugs. The type of medication used depends on the severity of the patient's high blood pressure, previous illnesses and risk factors.
ACE inhibitors for high blood pressure
ACE inhibitors block the so-called angiotensin converting enzyme: This enzyme is involved in the formation of the hormone angiotensin II, which causes a narrowing of the vessels. Thus, ACE inhibitors cause dilation of the blood vessels via a reduced production of angiotensin II, thus lowering blood pressure. Agents that work through this mechanism end in "-pril", such as ramipril.
AT1 receptor antagonists as a tolerable alternative
AT1 receptor antagonists have the same hormone system as ACE inhibitors. In contrast to these, however, they do not reduce the formation of angiotensin II, but they block the "docking" (receptor) of the hormone, through which it achieves its vasoconstrictive effect. This lowers blood pressure, although angiotensin II is still produced. As a result, certain side effects occasionally associated with the use of ACE inhibitors can be prevented. AT1 receptor antagonists have the suffix "-sartan" in the name of the active substance. Examples are candesartan or telmisartan.
Beta-Blocker: effect on kidneys and heart
Beta-blockers block certain receptors of epinephrine and norepinephrine. These messengers are released especially in stressful situations and then bind beta1-receptors on the kidney. This leads to the release of the enzyme renin, which in turn causes the formation of angiotensin II and thus an increase in blood pressure via several intermediate steps. By blocking the adrenaline and norepinephrine docking sites, beta blockers prevent this increase in blood pressure.
In addition, beta-blockers also block beta1 receptors in the heart, which increase the heart rate and cardiac output of adrenaline and norepinephrine, allowing the heart to pump more blood through the circulation in less time. Beta-blockers also have a "braking effect" on the heart, which also contributes to lowering blood pressure and also relieves the heart. Beta-blockers end in "-lol", such as bisoprolol or metoprolol.
Calcium antagonists dilate the vessels
Calcium antagonists inhibit specific calcium channels in the vascular musculature, thereby reducing the influx of calcium into the muscle cells. Due to the reduced calcium concentration, the muscle cells can contract less strongly, which leads to an expansion of the vessels and thus to a reduction in blood pressure. In this way, the calcium antagonists of the so-called nifedipine type. These drugs end in "-dipin", such as amlodipine.
Another subgroup is calcium antagonists such as diltiazem or verapamil. In addition, they have an effect on the heart muscle cells, where they lead to reduced cardiac output and to a reduction in the heart rate. On the one hand, diltiazem and verapamil prevent the heart from attempting to compensate for the drop in blood pressure due to an increased heart rate. This effect is a dangerous side effect of nifedipine-type drugs, especially in patients with coronary heart disease (CHD).
On the other hand, diltiazem and verapamil can also be used for cardiac arrhythmias.
Diuretics: dehydration in high blood pressure
Diuretics are medicines that promote the excretion of water in the kidney and thus have a dehydrating effect. In hypertension, especially so-called thiazide diuretics are used. These drugs block special transport systems in the kidney, eliminating more salt and water.
Drainage reduces the volume of blood in the blood vessels and thus reduces blood pressure. In addition, thiazide diuretics open potassium channels in the vascular muscle cells, making them less contractible, which also helps to lower blood pressure. An example of a diuretic used in hypertension is the active ingredient hydrochlorothiazide.