VIDEO
Treatment of High Blood Pressure and High Blood Cholesterol
Treatment with drugs
Having to take drugs for high BP is now common for many people in the
The goal of drug treatment with BP-lowering drugs is to:
• decrease the risk of cardiovascular disease (heart attack and stroke), associated with raised BP;
• control any risk of other cardiovascular risk factors that may be present such as raised cholesterol, diabetes, left ventricular hypertrophy, and other conditions that may need other drugs, aside from blood pressure-lowering drugs;
• improve your quality of life.
The choice of drug treatment will be ‘tailored’ to maximize the benefits and minimize the side effects according to your profile of these other risk factors, preferences for treatment and your circumstances.
There seems to be a lot of different drugs on the market for high BP. Are the benefits and risks of these drugs well established?
Drug treatment for high BP is probably one of the best researched areas in medical practice. Thousands of people have participated in clinical trials comparing BP-lowering drugs against a ‘dummy’ pill (an inactive compound – a ‘placebo’). In addition, various classes of BP-lowering drugs have been compared against each other. There remain contentious areas, such as the debate about the superiority of one class of BP-lowering drug over another class, particularly in people with different risk profiles. It is likely that over the next 5 years more definitive answers about the relative effectiveness of different classes of BP-lowering drugs will become clearer. At present a large study in the
Is a thiazide diuretic the best drug to use? Hasn’t this type been superseded by the newer classes of BP-lowering drugs?
Thiazide diuretics are probably the best studied class of BP-lowering drug. Thiazide diuretics decrease the rates of stroke and death. Low-dose thiazides are also associated with reduction in coronary heart disease. A recent landmark trial undertaken in the
The study conclusively shows that thiazide diuretics produce identical results compared with calciumchannel blockers and ACE inhibitors in terms of a reduction of coronary heart disease, death, and non-fatal heart attack. The centrally acting BP-lowering drug was shown to be inferior to the thiazide, particularly in those at risk from heart failure.
This
I am about to start on drugs for my high BP. What will I be given?
BP-lowering drugs are given according to the other risk factors that you may have. When you start a BP-lowering drug, your doctor should take into account your past medical history and risk factor profile when deciding on the most appropriate drug treatment. In addition you should be told about any side effects of the main classes of BP-lowering drugs.
How do most people get on once they start taking a BP-lowering drug?
Recent studies of low-dose BP-lowering drugs have shown that they are well tolerated by most people. About three-quarters of people treated with any of the common class of BP-lowering drugs had remained on their drug treatment when they were followed up 4 years later. In drug comparison studies (comparison of different classes of BP-lowering drugs), all the different classes of drugs were tolerated equally well. For most people thiazide diuretics remain the drugs of choice for those who have been newly diagnosed. The recent landmark study in the
They are as good (and in some circumstances) better than the newer BP-lowering drugs. So, your doctor will start you off on a thiazide diuretic but, if you have a particular risk profile, you might be started on a different BP-lowering drug. In general, alpha-antagonists and short-acting calcium-channel blockers are not given as a first drug.
You talk about side effects. What are the most common side effects of antihypertensive drugs and how frequently do they occur?
Tolerability and side effects are of course closely linked. However, side effects are specific to different classes of BP-lowering drug. For example, about a quarter of people receiving calcium-channel blockers have reported ankle swelling, a third of people receiving an ACE inhibitor report a dry cough, and about 10% of people receiving beta-blockers report having cold hands and feet (but see also the question on asthma and beta-blockers in the section on Problems requiring beta or alpha-blockers in Chapter 6). For most people, these side effects are not so disabling as to stop them taking their BP lowering drug. However, if you experience a side effect, however trivial, it is always worth discussing this with your GP or practice nurse when you are being reviewed in your surgery or clinic. It is important to report these to your doctor, because they can nearly always be avoided by a change in drug or dose.
How do I go about finding what classes of BP-lowering drugs I am on?
To find out about your own medication, first look at the name printed by your chemist on the container. If you are on more than one drug, and you think that you are being treated for other problems as well as high BP, you must decide which of them is for your BP – if you’re not sure, ask your chemist, or your doctor or practice nurse. Don’t forget that drugs have both generic Treatment with drugs (scientific) names, and brand names. Generic names are used throughout this book and tend to be common internationally. Most people in the
I was told at my check-up that my prescription seemed to be working well. By how much is my BP likely to have been reduced?
Used on their own, BP-lowering drugs in current use usually reduce BP by about 5–15 mmHg diastolic and about 10–25 mmHg systolic pressure. This response is quite variable in individual people. If drugs from different groups are combined, their effects are usually additive: over two-thirds of people taking BP-lowering drugs finally require two or more different agents.
