What about drug treatment?

Diuretic agents are often the first treatment chosen. These drugs help control blood pressure by getting rid of excess salt and water from your body. Some common diuretics are chlorthalidone (Hygroton). furosemide (Lasix). hydrochlorothiazide (Esidrix. Hydrodiuril). indapamide (Lozol) and metolazone (Mykrox, Zaroxolyn). These and other diuretics (see list beginning on page 12) are similar, though there may be differences in the length of action. Your doctor will probably use the one that he or she knows best.

Here are some drugs used to treat high blood pressure. Your doctor may prescribe others. This listing isn’t meant to be all-inclusive.

Generic Name      Trade (Brand) Name

Diuretics

Diuretics lower blood pressure by causing the body to rid itself of excess fluids and sodium through urination. If the desired effects aren’t achieved with diuretics alone, in combination they may enhance the effect of other blood pressure medications. Some commonly prescribed diuretics include:

Amiloride (Midamor)
Bumetanide (Bumex)
Chlorothiazide (Diuril)
Chlorthalidone (Hygroton)
Furosemide (Lasix)
Hydrochlorothiazide (Esidrix, Hydrodiuril)
Indapamide (Lozol)
Spironolactone fAldactone)

Angiotensin-Converting Enzyme (ACE) Inhibitors

These drugs expand blood vessels and decrease resistance. This allows blood to flow more easily and makes the heart’s work easier or more efficient. ACE inhibitors are used to treat symptoms of heart failure and to lower blood pressure. Commonly prescribed ACE inhibitors include:

Benazepril (Lotensin)
Captopril (Capoten)
Enalapril (Vasotec)
Fosinopril (Monopril)
Lisinopril (Prinivil, Zestril)
Moexipril (Univasc)
Perindopril (Aceon)
Quinapril (Accupril)
Ramipril (Altace)
Trandolapril (Mavik)

Angiotensin-2 Receptor Antagonists

Angiotensin-2 (AT-2) receptor antagonists have been shown to produce effects similar to those produced by ACE inhibitors. They may be better tolerated because they produce less cough. Rather than lowering levels of angiotensin II (as ACE inhibitors do), angiotensin II receptor blockers prevent this chemical from having any effects on the heart and blood vessels. This keeps blood pressure from rising. Some common products in this category include:

Candesartan (Atacand)
Eprosartan (Teveten)
Irbesartan (Avapro)
Losartan (Cozaar)
Olmesartan medoxomil (Benicar)
Telmisartan (Micardis)
Valsartan (Diovan)

Beta Blockers

Beta blockers decrease the heart rate and cardiac output, which lowers blood pressure. They’re also used with therapy for cardiac arrhythmias and in treating angina pectoris. Some commonly prescribed beta blockers include:

Acebutolol (Sectral)
Atenolol (Tenormin)
Betaxolol (Kerlone)
Bisoprolol/hydrochlorothiazide (Ziac)
Bisoprolol (Zebeta)
Carteolol (Cartrol)
Metoprolol (Lopressor, Toprol XL)
Nadolol (Corgard)
Propranolol (Inderal)
Sotalol (Betapace)
Timolol (Blocadren)

Combination Therapies

Atenolol and chlorthalidone (Tenoretic)
Bisoprolol and hydrochlorothiazide (Ziac)
Nadolol and bendrotlumcthiazide (Corzide)
Propranolol and hydrochlorothiazide (Inderide)
Timolol and hydrochlorothiazide (Timolide)

Calcium Channel Blockers

Calcium channel blockers, also known as “calcium antagonists,” interrupt the movement of calcium into heart and vessel cells. In addition to high blood pressure, they’re also used to treat angina (chest pain) and/or some arrhythmias (abnormal heart rhythms). Some commonly prescribed calcium channel blockers include:

Amiodipine (Norvasc, Lotrel)
Bepridil (Vascor)
Diltiazem (Cardizem, Tiazac)
Felodipine (Plendil)
Nifedipine (Adalat, Procardia)
Nimodipine (Nimotop)
Nisoldipine (Sular)
Verapamil (Calan, Isoptin, Verelan)

Combination Therapy – ACE inihibitor/diuretics

Benazepril and hydrochlorothiazide (Lotensin)
Enalapril and hydrochlorothiazide (Vaseretic)
Lisinopril and hydrochlorothiazide (Prinzide and Zestoretic)
Moexipril and hydrochlorothiazide (Uniretic)
Quinapril and hydrochlorothiazide (Accuretic)

Combination Therapy – Angiotensin II receptor antagonist/diuretic

Irbesartan and hydrochlorothiazide (Avalide)
Losartan and hydrochlorothiazide (Hyzaar)
Olmesartan medoxomil and hydrochlorothiazide (Benicar HCT)
Valsartan and hydrochlorothiazide (Diovan HCT)

Combination Therapy – ACE inihibitor/calcium channel blocker

Amiodipine and benazepril (Lotrel)
Enalapril and felodipine (Lexel)
Trandolapril and verapamil (Tarka)

Alpha Blockers

Doxazosin mesylate (Cardura)
Prazosin hydrochloride (Minipress)
Prazosin and polythiazide (Minizide)
Terazosin hydrochloride (Hytrin)

What about side effects?

Some of the drugs listed can affect certain functions of the body, resulting in bad side effects. Drugs that lower blood pressure have proven effective over the years. The benefits of using them far outweigh the risk of side effects. Most people who’ve taken these drugs haven’t had any problems.

Here are some of the side effects that may occur:

Diuretics

Some of these drugs may decrease your body’s supply of a mineral called potassium. Symptoms such as weakness, leg cramps or being tired may result. Eating foods containing potassium may help prevent significant potassium loss.

You can prevent potassium loss by taking a liquid or tablet that has potassium along with the diuretic, if your doctor recommends it. Diuretics such as amiloride (Midamor), spironolactone (Aldactone) or triamterene (Dyrenium) are called “potassium-sparing” agents. They don’t cause the body to lose potassium. They might be prescribed alone but are usually used with another diuretic. Some of these combinations arc Aldactazide, Dyazide, Maxzide or Moduretic.

Some people suffer from attacks of gout after prolonged treatment with diuretics. This side effect isn’t common and can be managed by other treatment.

In people with diabetes, diuretic drugs may increase the blood sugar level. A change in drug, diet, insulin or oral antidiabetic dosage corrects this in most cases. Your doctor can change your treatment. Most of the time the degree of increase in blood sugar isn’t much. Impotence may also be noted in a small percentage of people.

Beta blockers

Acebutolol (Sectral), atenolol (Tenormin), metoprolol tartrate (Lopressor), nadolol (Corgard), pindolol (Visken), propranolol (Inderal) or timolol (Blocadren) may cause insomnia, cold hands and feet, tiredness or depression, a slow heartbeat or symptoms of asthma. Impotence may occur. If you have diabetes and you’re taking insulin, have your responses to therapy monitored closely.

ACE inhibitors

These drugs, such as captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril or Prinivil), may cause a skin rash: loss of taste; a chronic dry, hacking cough; and in rare instances, kidney damage.

Angiotensin II receptor blockers

These drugs may cause occasional dizziness.

Calcium channel blockers

Diltiazem (Cardizem), nicardipine (Cardene), nifedipine (Procardia) and verapamil (Calan or Isoptin) may cause palpitations, swollen ankles, constipation, headache or dizziness. Side effects with each if these drugs differ a great deal.

Alpha blockers

These drugs may cause fast heart rate, dizziness or a drop in blood pressure when you stand up.

Combined alpha and beta blockers

People taking these drugs may experience a drop in blood pressure when they stand up.

Central agonists

Alpha methyldopa (Aldomet) may produce a greater drop in blood pressure when you’re in an upright position (standing or walking) and may make you feel weak or faint if the pressure has been lowered too far. This drug may also cause drowsiness or sluggishness, dryness of the mouth, fever or anemia. Male patients may experience impotence. If this side effect persists, your doctor may have to change the drug dosage or use another medication.

Clonidine (Catapres), guanabenz (Wytensin) or guanfacine (Tenex) may produce severe dryness of the mouth, constipation or drowsiness. If you’re taking any of these drugs, don’t stop suddenly, because your blood pressure may rise quickly to dangerously high levels.

Peripheral adrenergic inhibitors

Reserpinc may cause a stuffy nose, diarrhea or heartburn. These effects aren’t severe and no treatment is required other than a change in the amount of drug taken. If you have nightmares, insomnia or get depressed, tell your doctor. You should stop using the drug.

Guanadrel (Hylorel) or guanethidine (Ismelin) may cause some diarrhea. This may persist in some people. This side effect usually becomes less of a problem if you continue treatment.

These drugs reduce blood pressure more when you stand. So you may get dizzy and lightheaded and feel weak when you get out of bed in the morning or stand up suddenly. If you notice any of these reactions – and if they persist for longer than a minute or two – sit or lie down and either reduce or omit the next dose of the drug. If symptoms continue, contact your doctor.

When you’re taking guanethidine, don’t keep standing in the hot sun or at a social gathering if you begin to feel faint or weak. These activities cause low blood pressure. Male patients may experience impotence. Contact your doctor if this occurs. These drugs are rarely used unless other medications don’t help.

Blood vessel dilators

Hydralazine (Apresoline) may cause headaches, swelling around the eyes, heart palpitations or aches and pains in the joints. Usually none of these symptoms are severe, and most will go away after a few weeks of treatment. This drug isn’t usually used by itself.

Minoxidil (Loniten) is a potent drug that’s usually used only in resistant cases of severe high blood pressure. It may cause fluid retention (marked weight gain) or excessive hair growth.

If you know how these drugs may affect you – and know what to do about their side effects – it’ll be easier for you to continue treatment. Your patience will usually result in lower blood pressure and a longer life.

Some final advice

Treating high blood pressure is easy in most cases. But it may be complicated in some cases and require lots of time, patience and care by both doctor and patient. It may be annoying to take pills and possibly have side effects, especially if you felt fine before treatment.

Don’t be discouraged if you must be treated indefinitely. Some people can reduce their drug dosages after achieving normal blood pressure and maintaining it for a year or more. (You usually can’t stop treatment entirely.) Enduring the inconvenience of medication is still much better than suffering a stroke or heart attack. Most people who are successfully treated live a long and healthy life.

Not everyone with high blood pressure needs to be treated with drugs listed in this booklet. Some people may do just as well on other therapy. Don’t insist that your doctor use a certain drug because you’ve read or heard about its effect on other people. You can have a serious side effect if you take a “wonder drug” that isn’t right for you. Let your doctor decide what drug, if any, to use.

There are many drugs now being studied that may help in the future.

For more information

• Omron HEM-780 Automatic Blood Pressure Monitor with ComFit Cuff
• Omron HEM-790IT Automatic Blood Pressure Monitor with Advanced Omron Health Management Software
• Panasonic EW3006S Wrist Blood Pressure Monitor
• Coromega Omega-3 Supplement, Orange Flavor, Squeeze Packets, 90-Count Box
• The DASH Diet Action Plan: Based on the National Institutes of Health Research: Dietary Approaches to Stop Hypertension
• The Blood Pressure Miracle
• What Your Doctor May Not Tell You About: Hypertension: The Revolutionary Nutrition and Lifestyle Program to Help Fight High Blood Pressure
• The Blood Pressure Cure: 8 Weeks to Lower Blood Pressure without Prescription Drugs
• Harvard Medical School Guide to Lowering Your Blood Pressure
• In 12 weeks You Can Control Your High Blood Pressure Without Drugs

There are many educational booklets to help you make healthier choices to reduce your risk, manage disease or care for a loved one. Topics include

o nutrition and weight management
o smoking
o cholesterol
o high blood pressure
o physical activity
o controlling risk factors
o cardiovascular conditions
o treatments
o procedures
o stroke and more

To learn more, call toll-free at 1-800-AHA-USA1 (1-800-242-8721), or contact your nearest American Heart Association office. You can also visit the Web site, americanheart.org. For information on stroke, call 1-888-4-STROKE (1-888-478-7653) or visit online at StrokeAssociation.org.

Knowledge is power, so Leam and Live!

Heart Attack Warning Signs

Some heart attacks arc sudden and intense, but most of them start slowly, with mild pain or discomfort. Here arc some of the signs that can mean a heart attack is happening.

o Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.

o Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.

o Shortness of breath. May occur with or without chest discomfort.

o Other signs. These may include breaking out in a cold sweat, nausea or lightheadedness.

If you or someone you’re with has chest discomfort, especially with one or more of the other signs, don’t wait longer than five minutes before calling for help. Call 9-1-1… Get to a hospital right away. (Calling 9-1-1 is almost always the fastest way to get lifesaving treatment.)

If you’re the one having symptoms, and you can’t access emergency medical services (EMS), have someone drive you to the hospital right away. Don’t drive yourself, unless you have absolutely no other option.

Stroke Warning Signs

o Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

o Sudden confusion, trouble speaking or understanding

o Sudden trouble seeing in one or both eyes

o Sudden trouble walking, dizziness, loss of balance or coordination

o Sudden, severe headache with no known cause