There are many types of drugs available to treat high blood pressure

Some patients may require more than one drug in order to be able to control their high blood pressure sufficiently. — Filepic

I have been having high blood pressure (hypertension) for over 10 years. I have also been experiencing other issues like acid reflux. Recently, I changed my cardiologist and gastroenterologist. They told me that the calcium channel blockers I have been prescribed for years is causing my acid reflux, and that they have seen many cases like these in people aged 40 and above. What other types of antihypertensives are available?

There are many different high blood pressure medications (antihypertensives) available, each with their own pros and cons.

If one is not working for you, it is best to let your doctor know.

You can even seek different opinions from different doctors.

The common types used today are:

> Diuretics

Also called water pills, diuretics remove excess water and sodium from your body.

Less fluid flowing through your blood vessels will then reduce pressure on their walls.

There are different types of diuretics, such as thiazide, loop and potassium-sparing.

> Angiotensin-converting enzyme (ACE) inhibitors

These prevent the formation of the hormones angiotensin 1 to 3 that narrow blood vessels.

Therefore, your blood vessels will be less constricted, and thus, less pressurised.

> Angiotensin-2 receptor blockers (ARBs)

These drugs block the hormone angiotensin 2 from fitting into AT1 receptors on cells, thus, preventing its action of narrowing blood vessels.

> Calcium channel blockers

These prevent calcium from entering the cells of the heart and arteries, allowing the arteries to relax.

> Beta blockers

These older drugs block the effects of adrenaline, causing your heart to beat slower and with less force.

> Renin inhibitors

Renin is a substance produced by the kidneys that triggers a series of steps that increases blood pressure.

Renin inhibitors inhibit renin production.

Wow, there are so many to choose from!

There are even more. Here are some of the older drugs:

> Alpha blockers

They prevent noradrenaline from tightening the muscles in the walls of the smaller arteries and veins, which causes the vessels to remain open and relaxed.

> Alpha-beta blockers

These work similarly to beta blockers.

> Central-acting agents

These prevent your brain from sending signals to your nervous system to speed up the heart rate and narrow blood vessels.

As a result, your heart doesn’t pump as hard.

> Vasodilators

These prevent the muscles in your blood vessels from tightening and narrowing.

> Aldosterone antagonists

These block aldosterone, which sometimes causes salt and fluid retention, contributing to high blood pressure.

I was prescribed a combination antihypertensive in one pill. Why are we sometimes prescribed a combination of drugs?

How well a drug works depends on the person’s age, sex, race, blood pressure level and overall health.

Combining two drugs usually works better than a single drug to get blood pressure under control.

Sometimes, even three or four drugs are required!

There are now plenty of combination drugs, usually two in one, which are ready-made in a single pill for our convenience.

What is the right choice for me?

Let’s talk about the Health Ministry’s guidelines for hypertension.

In my opinion, these are very well thought out and better than a lot of other guidelines out there, which tend to cater for Western patients.

If you are being diagnosed with hypertension for the first time, you will be staged according to severity.

In our guideline, Stage 1 is 140/90 mmHg measured in a clinic, or 130/85 mmHg if you measure it at home on a blood pressure monitor.

Stage 2 is 160/100 mmHg in a clinic, or 155/95 mmHg at home.

Stage 3 is over 180/110 mmHg in a clinic.

Then there are risk factors to consider.

These are all put in a table and your risk is carefully calculated.

They include:

• Diabetes
• High cholesterol levels
• Cigarette-smoking
• Central obesity, which means in men, your waist measures over 90cm, and women, over 80cm.
• Microalbuminuria/proteinuria (which has to be measured with a dipstick in your urine sample)
• Age of over 55 years for men, and over 65 for women
• Family history of cardiovascular disease
• Physical inactivity, like a desk job or sedentary lifestyle.

When I first started going for my check-ups, my blood pressure was 132/82 mmHg. My GP (general practitioner) was a little worried, but he didn’t start me on medications until it went past 140/90 mmHg. He was correct, right?

Yes, for such a reading, you would need to be rechecked at a clinic within six months.

If your blood pressure remains the same, is is called pre-hypertension, which is defined as a blood pressure of 120-139/80-89 mmHg.

Long, long ago, this used to be called borderline hypertension, but the term has been dropped because it confuses and makes patients anxious.

If you have this, you are at increased risk of progressing to hypertension.

During this time, your blood pressure should be monitored frequently.

No drugs are required if you have low risk, but lifestyle changes certainly are.

But if you have risk factors as outlined above, then a drug may be prescribed for you.

See the next Tell Me About for the lifestyle changes you should make.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email [e-mail]. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.