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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