Choosing A Blood Pressure Medicine
Should not be done by chance. A blood pressure medicine can be expected to have effects other than the desired effect on blood pressure, both desirable and undesirable. Why not make use of them?
For instance a blood pressure medicine that has a nice effect on blood pressure and also on angina pectoris (Coronary artery narrowing with chest pain) would be very useful in someone who has both.
ACE inhibitors have a strong effect on high blood pressure and have a good effect on heart failure as well. A good choice in someone with both.
It seems then that certain medications are the clear choices for hypertensive people with certain other conditions. In other words, those certain other conditions would compel the choice of a particular blood pressure medicine. This introduces and explains the concept of compelling indications.
If you haven't read my other two pages on anti-hypertensive medications please SEE Blood Pressure Medication and Blood Pressure Medications
The first is a general overview and the second is a discussion of the five classes of medication considered frontline in reducing morbidity and mortality.
Following are some of the medical conditions that would "compel" the choice of blood pressure medicine and the drug choices are listed beneath:
Coronary Artery Disease (includes Angina and Heart Attack)
ACE inhibitors. These have even more effect on reducing stroke than reducing heart attack.
Congestive Heart Failure
Diuretics. CHF includes the build-up of fluid. Get the idea?
ACE inhibitors. Angiotensin receptor blockers [ARB's] have actions similar to ACE inhibitors.
Diuretics for the Diabetics—Rhyme for more reason than one.
ACE inhibitors and ARB's. An important protective effect on the kidney.
Chronic Kidney Disease (Creatinine of 1.5 in men and 1.3 in women)
ACE inhibitors and ARB's.
One blood pressure medication is not enough. Most of these patients require 3 or more medications to achieve desirable levels.
Cerebrovascular Disease (Stroke)
Diuretics. These are even more effective in stroke than in heart attack.
ACE inhibitors and ARB's may be useful.
Diuretics as in the general recommendations. Reduce fractures by reducing Calcium loss.
No clear compelling indication here. Blood pressure control slows cognitive impairment!
Ethnic and Racial Considerations
Diuretics work best in blacks because they tend to have low-renin hypertension.
Calcium channel blockers (CCB's) are also preferred.
Left Ventricular Hypertrophy
Mainly avoid the direct vasodilators such as minoxidil and hydralazine, which do not reverse the hypertrophy as the others do.
Peripheral Arterial Disease and Postural Hypotension
No special considerations. Just watch them carefully.
Blood Pressure Medicine In Women
Recommendations are the same as for the general population.
With any possibility of pregnancy, avoid ACE inhibitors and ARB's and the beta-blockers atenolol and labetolol.
There are no known special considerations specific to childhood.
All five main frontline classes of anti-hypertensive medication work in children.
Doctor's Practical Guide
This is just an overview of this subject for your general information and understanding. The better you understand the better you will be able to work with your doctor to optimally manage your blood pressure medicine. Choosing a blood pressure medicine is a job for the professionals but there is nothing wrong with you having a little knowledge.
Do not lose sight of the non-pharmaceutical ways to lower blood pressure. SEE Lower Blood Pressure
Nor should you forget about "white-coat hypertension" and that to eliminate this false elevation of your blood pressure you must learn to take it yourself. It's easy and you can do it. SEE How To Take Blood Pressure
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