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Blood pressure medication
There are 4 main classes of antihypertensive drugs commonly prescribed:

Angiotensin converting enzyme (ACE) inhibitors

Angiotensin receptor blockers (ARBs)

Calcium channel blockers (CCBs)

Diuretics
Less commonly used antihypertensive drugs include alpha blockers, beta blockers, renin inhibitors and centrally acting antihypertensives (central alpha agonists).
These are not first line choices for hypertension and will not be discussed here; for more information visit www.bnf.org.uk or www.bpassoc.org.uk.
There are two main modes of action of antihypertensive medication:

Decreasing vascular resistance by dilating/preventing constriction of blood vessels

Decreasing blood volume by diuresis
ACE inhibitors
How they work

Block production of angiotensin-II, preventing its vasoconstrictive effect

Inhibit production of aldosterone, which is stimulated by angiotensin-II, preventing sodium and water retention by the kidneys and producing a diuretic
effect
Common names
All ACE inhibitors have the suffix –opril, the most common being:

Captopril (Acepril, Capoten, Capozide)

Enalapril (Innovace)

Lisinopril (Carace, Zestoretic, Zestril)

Perindopril (Coversyl)

Ramipril (Lopace, Tritace)
Indications

First drug of choice for hypertension in <55’s, non Afro-Carribean

Hypertension in diabetes or renal disease
Side effects

Persistent dry cough (most common, due to inhibition of breakdown of kinins by the drug)

Dizziness, tiredness, weakness, rash, headaches, dysgeusia, blood dyscrasias, headache, myalgia, arthralgia

Allergic reactions (rarely)
ARBs
How they work
Block angiotensin-II receptors, preventing its vasoconstrictive action and inhibiting aldosterone production, similar to ACE inhibitors, but do not inhibit kinin breakdown
Common names
All ARBs have the suffix –sartan, the most common being:

Valsartan (Diovan)

Losartan potassium (Cozaar)
Indications

Hypertension in people <55, non Afro-Caribbean, who develop side effects with ACE inhibitors (may also be prescribed as first drug of choice)

Hypertension in diabetes or renal disease
Side effects

Dizziness, headache, cold/flu-like symptoms (generally mild)

Allergic reactions, myalgia, arthralgia, back pain (very rarely)
CCBs
How they work
Block calcium entry into vascular smooth muscle cells, preventing its vasoconstrictive action
Common names
Most CCBs have the suffix –ipine, the most common being:

Amlodipine (Exforge)

Nifedipine (Adalat)

Verapamil (Verapress)

Diltiazem hydrochloride (Tildiem, Adizem)
Indications

First drug of choice for hypertension in >55’s, Afro-Carribean

More severe hypertension
Side effects

Abdominal pain, nausea, oedema, flushing, headaches, dizziness, sleep disturbance, fatigue (common)

Myalgia, cramps, back pain, arthralgia, constipation, rashes, flushed face, urinary disturbance (less common)

Swollen or bleeding gums (rarely)
Diuretics
How they work
Decrease blood volume by inhibiting electrolyte (and therefore water) reabsorption in the kidney, leading to increased urine production. Thiazides are most commonly
prescribed for hypertension
Common names
Several in each class, the most common being:

Thiazides – Bendroflumethiazide

Loop diuretics – Furosemide (Frusemide, Lasix), Bumetanide (Burinex)

Potassium-sparing diuretics – Amiloride hydrochloride (Amiloride. Moduretic), Spironolactone (Idactone)
Indications

Thiazides – Hypertension (alone for mild hypertension or in combination with other antihypertensives for moderate hypertension)

Loop diuretics – Resistant hypertension, patients with impaired renal function or heart failure (in combination with other antihypertensives)

Potassium-sparing diuretics – Given in combination with thiazide or loop diuretics as a more effective alternative to potassium supplements
Side effects

Mild GIT disturbance, postural hypotension, altered plasma-lipid concentrations; metabolic and electrolyte disturbances including hypokalaemia (except
with potassium-sparing diuretics), hyponatraemia, hypomagnesaemia, hypercalcaemia, hyperglycaemia, hyperuricaemia and gout (common)

Blood dyscrasias, impotence (less common)


Hypersensitivity reactions, headache, dizziness, arrhythmias, pancreatitis, intrahepatic cholestasis (rare)
Paraesthesia and myalgia with loop diuretics