High Blood Pressure Treatment (cont.)
In this Article
Which medications are used to treat high blood pressure?
Angiotensin converting enzyme inhibitors (ACE Inhibitors) and angiotensin receptor blockers
The angiotensin converting enzyme (ACE) inhibitors and the
angiotensin receptor
blocker (ARB) drugs both affect the renin-angiotensin hormonal system which helps regulate blood pressure. ACE inhibitors by blocking (inhibiting) an enzyme that converts the inactive form of
angiotensin in the blood to its active form. The active form of angiotensin
constricts or narrows the arteries, but the inactive form cannot. With an ACE
inhibitor as a single drug treatment (monotherapy), 50 to 60 percent of
Caucasians usually achieve good blood pressure control. African American patients may also
respond, but they require higher doses and frequently do best when an ACE
inhibitor is combined with a diuretic. (Diuretics are discussed below.)
As an added benefit, ACE inhibitors may reduce an enlarged heart (left ventricular hypertrophy) in patients with hypertension. These drugs also appear to slow the deterioration of kidney function in patients with hypertension and protein in the urine (proteinuria). They have been particularly useful in slowing the progression of kidney dysfunction in hypertensive patients with kidney disease resulting from Type 1 diabetes (insulin-dependent). ACE inhibitors usually are the first line drugs to treat high blood pressure in cases that also involve congestive heart failure, chronic kidney failure in both diabetics and non-diabetics, and heart attack (myocardial infarction) that weakens the heart muscle (systolic dysfunction). ARB drugs are
currently recommended for first line renal protection in diabetic nephropathy
(kidney disease).
Patients treated with ACE inhibitors who also have kidney disease should be monitored for further deterioration in kidney function and high serum potassium. These drugs may be used to reduce the loss of potassium in people who are being treated with diuretics that cause patients to lose potassium. ACE inhibitors have few side effects. One bothersome side effect is a chronic cough.
The ACE inhibitors include:
For patients who develop a chronic cough on an ACE inhibitor, an ARB drug is a good substitute. ARB drugs work by blocking the angiotensin receptor (binder) on the arteries to which activated angiotensin must bind to have its effects. As a result, the angiotensin is not able to work on the artery. (Angiotensin is a hormone that constricts the arteries.) ARB drugs appear to have many of the same advantages as the ACE inhibitors but without the associated cough. They are also suitable as first line agents to treat hypertension.
ARB drugs include:
In patients who have hypertension in addition to certain second diseases, a combination of an ACE inhibitor and an ARB drug may be effective in controlling the hypertension and also benefiting the second disease. This combination of drugs can treat hypertension and reduce the loss of protein in the urine (proteinuria) in certain kidney diseases and perhaps help strengthen the heart muscle in certain diseases of the heart muscle (cardiomyopathies). Both the ACE inhibitors and the ARB drugs are not to be used (contraindicated) in pregnant women. (See the section above on pregnancy.)
Next: Beta-blockers »
- ACE Inhibitors - Read about ACE inhibitors like Altace, lisinopril, enalapril, ramparil, Zestril and more. Information includes side effects, drug interactions, and pregnancy safety information.
- Congestive Heart Failure - Read about congestive heart failure symptoms like fatigue, abdomen, leg and ankle swelling, shortness of breath, sleeplessness, increased urination, nausea, abdominal pain, and decreased appetite.
- Beta Blockers - Learn more about Beta Blockers, a drug that treats angina and other heart rhythm disorders, migraines, high blood pressure, panic attacks, and tremors. Generic and brand names are included in the article.
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