Hypertension is a disease that is as widespread as it is underestimated. In order to avoid secondary diseases such as heart attack , stroke or kidney damage, it is important to recognize and treat high blood pressure in good time. Often all it takes is a lifestyle adjustment with a healthy diet, exercise and renouncing nicotine to lower blood pressure below the limit of 140/90 mmHg.
Drug therapy as the last step
Drug therapy is only necessary if the blood pressure values do not fall despite a healthy lifestyle. Which of the numerous drugs against high blood pressure is best suited depends on many factors and must be decided by the doctor individually for each patient. We have put together an overview of the various antihypertensive drugs for you.
High blood pressure: treatment with medication
In the treatment of high blood pressure, there are five central drug groups from which the doctor selects a drug that is suitable for the patient at the beginning of treatment:
AT1 receptor antagonists
Alpha blockers, aldosterone antagonists or direct vasodilators are also sometimes used. If the selected medication does not have an adequate effect, the doctor can either change the product or combine two active ingredients. The drug with which treatment is started depends on the severity of the high blood pressure as well as the patient’s previous illnesses and risk factors. Below you will find the five most commonly used drug groups in detail.
ACE inhibitors for high blood pressure
ACE inhibitors block the so-called angiotensin converting enzyme: This enzyme is involved in the formation of the hormone angiotensin II, which causes the blood vessels to constrict. ACE inhibitors thus cause the blood vessels to widen by reducing the production of angiotensin II and thus lowering blood pressure. Active ingredients that work through this mechanism end in “-pril”, such as ramipril.
AT1 receptor antagonists as a tolerable alternative
AT1 receptor antagonists work through the same hormonal system as ACE inhibitors. In contrast to these, however, they do not reduce the formation of angiotensin-II, but rather block the “docking point” (receptor) of the hormone through which it achieves its vasoconstricting effect. This lowers blood pressure even though angiotensin-II is still being produced. According to the current state of knowledge, this can prevent certain side effects that occasionally occur when taking ACE inhibitors. AT1 receptor antagonists have the ending “-sartan” in the name of the active ingredient. Examples are candesartan or telmisartan.
Beta blockers: effects on the kidneys and heart
Beta blockers block certain receptors of adrenaline and noradrenaline. These messenger substances are released especially in stressful situations and then bind beta1 receptors to the kidney. This leads to the release of the enzyme renin, which in turn causes the formation of angiotensin-II and thus an increase in blood pressure via several intermediate steps. By blocking the docking sites for adrenaline and noradrenaline, beta blockers prevent this increase in blood pressure.
In addition, beta-blockers also block beta1 receptors in the heart, through which adrenaline and noradrenaline increase the heart rate and the heart’s beating power, so that the heart can pump more blood through the circulation in a shorter time. Beta blockers also have a “braking effect” on the heart, which also contributes to lowering blood pressure and also relieves the heart. Beta blockers end in “-lol”, such as bisoprolol or metoprolol .
Calcium antagonists dilate the blood vessels
Calcium antagonists inhibit special calcium channels in the vascular muscles and thereby reduce the influx of calcium into the muscle cells. Due to the reduced calcium concentration, the muscle cells can contract less, which leads to an expansion of the vessels and thus to a lowering of blood pressure. This is how the calcium antagonists of the so-called nifedipine type work. These active ingredients end in “-dipine”, such as amlodipine .
Calcium antagonists such as diltiazem or verapamil form another subgroup. They also have an effect on the heart muscle cells and lead to a reduced heart rate and a lowering of the heart rate. On the one hand, diltiazem and verapamil prevent the heart from attempting to compensate for the drop in blood pressure with an increased heart rate. This effect is a dangerous side effect of drugs of the nifedipine type, especially in patients with coronary artery disease (CHD).