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Established in 1983

Action: Reduce the effect of renin and angiotensin on the blood vessels of the body and lower the blood pressure. In many forms of hypertension the kidneys over produce ACE and it is usually very beneficial to reduce the blood vessel constricting effects of ACE.

Benefit: Probably the blood pressure lowering medication in existance with the most far-reaching benefit. Other than lowering blood pressure reliably and at a low cost (most are $4/month generics) the pleotrophic (collateral) effects are to reduce heart attacks, strokes, kidney damage, retinal disease, and delay onset of diabetes.

Side-effects: About 7% of users get a dry cough. When this happens the advice is to discontinue use of the drug because another condition, known as angioedema (choking or swelling of the throat,) a rare but potentially serious condition can occur. Serum potassium (K+) is sometimes elevated by these drugs, and needs to be monitored.

Examples: (Geric/brand names//usual doses) Lisinopril/Prinivil//5-40mg 1-2 X daily , Enalapril/Vasotec//5-40mg 1-2X daily, Ramipril/Altace//1.25-10 mg daily, Captopril/12.5-100mg 2-3X daily.

Action: Similar to ACE-I’s, but work on the receptor site of angiotensin-1, not the synthesis of it. Angiotensin-2 is not blocked and this is at least a potential problem with these drugs.

Benefit: Similar to ACE-I’s, but as yet there are no generics and cost is greater. The lack of blockage of angiotensin-2 is more of a theoretical problem, but may develop into a major issue as more research clarifies this issue. We do know that kidney disease is reduced, heart failure is benefitted and stroke is reduced by the use of ARB’s.

Side-effects: Probably our cleanest drug family in terms of side-effects. For the most part, the most common problem would be too great a drop in blood pressure with dizziness or fainting. Naturally, this would require a reduction in dosage or use of a weaker drug.

Examples: Valsartin/Diovan//40-320mg daily, Candisartin/Cozar or Hyzar//25-100mg daily,

Action: Adrenalin and adrenalin-like substances are released in the system to raise the heart rate, contractility of the heart and constrict blood vessels. The first two effects are the B- or beta effects. Blood vessel constriction is the A- or alpha effect. B-blockers have varying effects on the A-adrenergic system, but mostly the effect does neither help nor hurt the control of blood pressure. The primary role of B-blockers is to lower blood pressure by lowering the output of the heart (heart rate X contractility.)

Benefit: If an individual has an over-stimulated adrenergic system (“hyper” individual) blood pressure will be lowered comfortably. Heart failure patients and those with enlarged hearts usually find their conditions improved with these drugs. Patients with “palpitations” or migraine headaches can benefit from relief of both symptoms and lowering of blood pressure.

Side-effects: Fatigue, lack of energy, and reduced exercise training rate are common but decline with time. Propranolol causes nightmares, but the others do not. All B-blockers can make asthma and emphysema worse, but the cardio-specific B-blockers, like metaprolol and atenolol, are not as severe as the other, non-cardio-selective B-blockers, Propranolol and Carvetalol. All B-blockers can cause sexual dysfunction, increase in cholesterol, increase in blood sugar, and in diabetics, reduced awareness of drops in blood sugars.

Examples: Atenalol/Tenormin//12.5-100mg daily, Metaprolol/Toprol XL//12.5-200mg daily, Carbetalol/Coreg//3.25-25mg 2-3 X daily, and Propranolol/Inderal//20-100 mg 2 X daily.

Action: These drugs relax the smooth muscle cells in the walls of arteries, allowing them to dilate.

This lowers blood pressure and allows the heart to circulate more blood with less work.

Benefit: Lowering the workload on the heart is beneficial to the heart, but the results are similar to the ACE-I’s and ARB’s above and not as beneficial in heart failure. Some CCB drugs also lower heart rate (diltiazem and verapamil) and would be useful in heart rhythm situations. Some CCB’s are useful in spasm situations like angina, reynauds disease of the hands, and migraine headache.

Side-effects: Swelling of feet and ankles is common with amlodipine. Constipation is common with verapamil. Sexual side-effects may occur in all of them.

Examples: Verelan/Verapamil//30-360 mg 2-3x daily, Diltiazem/Cardizem//30-90mg 2-3xdaily, nifedipine/Procardia//30-90mg daily, Amlodipine/Norvasc//2.5-10mg daily.

Action: These drugs cause the kidneys to get rid of sodium (salt) and water, reducing the volume of fluids in the body and reduces blood pressure.

Benefit: Inexpensive and generally safe, these drugs decrease swelling, lung congestion, night time urinary frequency, and are the #1 recommended blood pressure lowering medication by all guideline-setting committees in the heart business. Most cardiologists do not concur, but these drugs are still very commonly used.

Side-effects: Most diuretics lower the potassium level in the blood, and this can be a life threatening problem. Blood tests are needed on a frequent basis to ensure continued safety. Often, potassium is co-administered to achieve a balance or a second diuretic (Spironolactone, Triampterene, or Inspira) is added to or combined with the primary diuretic to add a “potassium-sparing” action to achieve balance. Diuretics can frequently make people dizzy by lowering the “orthostatic” blood pressure, the lowered blood pressure resulting form stooping, squatting, and rising suddenly from sitting or lying. To a lesser degree, calcium, thiamine, magnesium and other trace minerals may be wastedin the diuretic process and deficiency result. Some patients have a rise in blood sugar and become diabetic. Kidney damage or failure may result form the action of these drugs and dialysie would be required. Despite this, these drugs are very frequently used and added to many ACE-I, ARB, B-blockers, and CCB drugs. This is frequently signaled by the notation: drug name/HCTZ.

Examples: Hydrochlorothiazide/(HCTZ)//12.5-50 mg daily, Triampterene and hydrochlorothiazide/Dyazide//37.5+25 mg each daily, Chlorthalidone//25-100mg daily, Furosemide/Lasix//20-80mg 1-2 X daily, Torsemide/Demadex//20-100 mg daily, and Bumetanide/Bumex//2-4 mg daily. The last three diuretics are rarely used for hypertension and are common in heart failure patients.