Monday, November 30th, 2009

Know Your Anti-hypertensive Medicines



If the BP is 140/90 lifestyle changes are recommended to bring down the blood pressure and if it’s more than this, then medicines and lifestyle changes work together to tame the blood pressure, said Dr. K.K Aggarwal, consultant cardiologist with Moolchand hospital.

Which lifestyle changes can help you bring the blood pressure down?

• Diet in moderation, all seven colour with six tastes.
• Food eaten should be less in refined carbs, low in saturated fat, high fiber and should have zero transfat.
• Exercise: 10,000 steps, or 60 minutes walk, or 30 minutes brisk walk or 20 minutes jogging or swimming daily, all seven days a week.
• Pranayama, relaxation and yoga 20 minutes daily.

Medicines that work in tandem with lifestyle changes to manage hypertension mostly belong to four groups: thiazides, ACE inhibitors, calcium channel blockers and beta blockers.

Diuretics are the first line of treatment to manage hypertension. It works by causing kidneys to excrete more water and sodium. It reduces the fluid volume through out the body and widens blood vessels. If a low-dose thiazide alone is not effective in reducing blood pressure, experts recommend that an ACE inhibitor, calcium channel blocker, or beta blocker is added or substituted.

1. ACE inhibitors — Angiotensin-converting enzyme (ACE) inhibitors constitute a family of drugs that inhibits narrowing of blood vessels and decreases blood pressure. It is used to treat high blood pressure and heart failure, as well as to improve survival following a heart attack. ACE inhibitors are also used to slow the progression of kidney disease in people with diabetes.
Generic names: The medicines belonging to this group have pril suffixed to their names, like benazepril,
Angiotensin II receptor blockers
They work on the same principle as ACE inhibitors but with fewer side effects.
Generic names: candesartan, irbesartan, losartan, telmisartan, and valsartan

2. Calcium channel blockers — True to their name these medicines hinder the flow of calcium entering blood vessel walls and heart muscles. In the absence of calcium, muscle cells can’t contract and stay in a relaxed state. There are two major categories of calcium channel blockers:
Dihydropyridines, include amlodipine and others with ‘pine’ suffix.
Nondihydropyridines, including diltiazem and verapamil

3. Beta blockers — Beta blockers block some of the effects of the sympathetic nervous system, which increases the heart rate and raises blood pressure with stress and/or activity. Beta blockers lower blood pressure in part by decreasing the rate and force at which the heart pumps blood.
Generic names–Medicines in this group include atenolol and others with ‘olol’ attached behind their names.

What’s the best time to take antihypertensive medicines? Dr. Hansa Gupta, cardiologist  says, “Mornings are best suited to take medicines, as it prepares you to handle the stressful events of the day in a better way by keeping your blood pressure low. Biologically, there is a dip in blood pressure during the nighttime. But, for patients whose blood pressure is difficult to manage we give another dose of medicines once again in the evening.”

Side effects

“The side effects associated with the use of these medicines to manage blood pressure are far less than the complications which can happen if you don’t use them,” reasons Dr. Gupta.

Side effects can be—=

ACE Inhibitors: Dry Cough
Beta Blockers: Fatigue and Impotence
Calcium Channel Blockers: Water Retention

“A side effect with a medicine doesn’t mean that you can stop it on your own,” cautions Dr K.K. Aggarwal. Meet with your doctor who will substitute the medicine with another.

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