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All information on high blood pressure (hypertension) blood pressure measuring blood pressure causes of high blood pressure high blood pressure level white coat syndrome symptoms of high blood pressure diagnosis of high blood pressure isolated systolic hypertension causes of isolated systolic hypertension white coat hypertension borderline hypertension malignant hypertension labile hypertension pulmonary hypertension renovascular hypertension high blood pressure risk factors complications of high blood pressure body weight and hypertension treatment options for high blood pressure high blood pressure medications lifestyle for hypertension high blood pressure diet

What medications are available for high blood pressure?

Aggressive drug treatment of long-term high blood pressure can significantly reduce the incidence of mental decline and death from heart disease and other serious physical effects of hypertension. In people with diabetes, controlling both blood pressure and blood glucose levels prevents serious complications of that disease. Anti-hypertensive agents may even prevent mental decline, including in people genetically susceptible to Alzheimer's disease. There are many types of medications used to treat high blood pressure. Angiotensin-converting enzyme inhibitors, or ACE inhibitors, block the production of a body chemical that constricts the arteries. ACE inhibitors include benazepril hydrochloride, enalapril maleate, and quinapril hydrochloride. Angiotensin II receptor blockers block the effect of a body chemical that constricts the arteries. This group of medications includes valsartan, losartin potassium, and candesartan.

Beta-blockers lower the heart rate and increase the amount of blood pumped with each heartbeat. Common beta-blockers include atenolol, propanolol hydrochloride, and nadolol. Calcium channel blockers lower the heart rate and relax the blood vessels. Some common calcium channel blockers include amlodipine besylate, diltiazem hydrochloride, nifedipine, and verapamil. Diuretics, or water pills, help the body get rid of extra fluid and sodium. Common diuretics include furosemide, hydrochlorothiazide, and chlorthalidone. . Sympathetic nerve inhibitors keep the nervous system from constricting arteries. This group includes clonidine hydrochloride, guanabenz acetate, and alpha methyldopa. Vasodilators relax the muscles in the blood vessel walls and allow the vessels to dilate. Common vasodilators include isosorbide dinitrate and hydralazine.

Water pills (diuretics)

Diuretics are used very widely to control mildly high blood pressure. They increase urine output, decrease blood volume, and dilate the arteries. These actions lower blood pressure. Usually diuretics are given in combination with other classes of blood pressure medications. Diuretics are among the oldest known medications for treating hypertension. They work in the tiny tubes (tubules) of the kidneys to remove salt from the body. Diuretics may be used as single drug treatment (monotherapy) for hypertension. More frequently, however, low doses of diuretics are used in combination with other anti-hypertensive medications to enhance the effect of the other medications.

The diuretic hydrochlorothiazide (Hydrodiuril) works in the far end (distal) part of the kidney tubules. In a low dose of 12.5 to 25 mg per day, this diuretic may improve the blood pressure-lowering effects of other anti-hypertensive drugs. The idea is to treat the hypertension without causing the adverse effects that are sometimes seen with the higher doses of hydrochlorthiazide. These side effects include potassium depletion and elevated levels of triglyceride (fat), uric acid, and glucose (sugar).

Occasionally, when salt retention causing swelling (edema) is a major problem, the more potent loop diuretics may be used in combination with other anti-hypertensive medications. (The loop diuretics are so called because they work in the loop segment of the kidney tubules to eliminate salt.) The most commonly used diuretics to treat hypertension include hydrochlorthiazide, the loop diuretics, furosemide (Lasix) and torsemide (Demadex), the combination of triampterene and hydrochlorothiazide (Dyazide), and metolazone (Zaroxolyn). Note that diuretics probably should not be used in pregnant women.

Beta-blockers

Beta-blockers reduce heart rate and decrease the force of heart contraction, thereby reducing the pressure generated by the heart. They are preferred in people who have associated coronary heart disease, angina, or recent heart attack. Beta-blockers include Propranolol (Inderal), metoprolol (Lopressor), atenolol (Tenormin).

The sympathetic nervous system is a part of the nervous system that helps to regulate certain involuntary (autonomic) functions in the body, including those of the heart and blood vessels. As part of that system, beta-receptors (receivers that respond to stimuli) in the heart increase the heart rate and the strength of heart contractions (pumping action). Beta-blockers acting on the heart, therefore, slow the heart rate and reduce the force of cardiac contraction. Meanwhile, beta-receptors in the smooth muscle of the peripheral arteries in tissues throughout the body and in the smooth muscle of the lung airways serve to relax these muscles.

Accordingly, beta-blockers cause contraction of the smooth muscle of the peripheral arteries and thereby decrease the blood flow to the tissues throughout the body. As a result, the patient may experience, for example, coolness in the hands and feet. Likewise, in response to the beta-blockers, the airways are squeezed (constricted) by the contracting smooth muscle. This squeezing (impingement) on the airway causes wheezing, especially in individuals with a tendency for asthma. In short, beta-blockers reduce both the force of the heart's pumping action and the blood pressure that the heart generates in the arteries.

Beta-blockers remain useful medications in treating hypertension, especially in patients with a fast heartbeat while resting (tachycardia), cardiac chest pain (angina), or a recent heart attack (myocardial infarction). For example, beta-blockers appear to improve long-term survival when given to patients who have had an acute heart attack. Whether beta-blockers can prevent heart problems (are cardio-protective) in patients with hypertension any more than other anti-hypertensive medications, however, is uncertain. Beta-blockers do seem to help treat chronic anxiety or migraine headaches in people with hypertension. The common side effects of these drugs include depression, fatigue, nightmares, sexual impotence in males, and increased wheezing in people with asthma. The beta-blockers include atenolol (Tenormin), propranolol (Inderal), and metoprolol (Toprol).

Calcium channel blockers

Calcium-channel blockers reduce muscle tension in the arteries, expanding them and creating more room for the blood flow. In addition, they slightly relax the heart muscle so it beats more slowly, reducing blood pressure. Calcium channel blocking agents work by relaxing the muscle in the walls of the arteries. They also reduce the force of contraction of the heart. Calcium channel blocking agents include Nifedipine (Procardia), diltiazem (Cardizem), verapamil (Isoptin, Calan), nicardipine (Cardene), amlodipine (Norvasc), felodipine (Plendil). Calcium channel blockers inhibit the movement of calcium into the muscle cells of the heart and arteries. The calcium is needed for these muscles to contract. These drugs, therefore, lower blood pressure by decreasing the force of the heart's pumping action (cardiac contraction) and relaxing the muscle walls of the arteries. Three major types of calcium channel blockers are used. One type is the dihydropyridines, which do not slow the heart rate or cause other abnormal heart rates or rhythms (cardiac arrhythmias). These drugs include amlodipine (Norvasc), sustained release nifedipine (Procardia XL, Adalate CC), felodipine (Plendil), and nisoldipine (Sular).

The other two types of calcium channel blockers are referred to as the non-dihydropyridine agents. One type is verapamil (Calan SR) and the other is diltiazem (Cardizem, Tiazac, Dilacor). Both the dihydropyridines and the non-dihydropyridines are very useful when used alone or in combination with other anti-hypertensive agents. The non-dihydropyridines, however, are not recommended (contraindicated) in congestive heart failure or with certain arrhythmias. Sometimes, however, these same dihydropyridines are useful in preventing certain other arrhythmias.

Many of the calcium channel blockers come in a short-acting form and a long-acting (sustained release) form. The short-acting forms of the calcium channel blockers, however, may have adverse long-term consequences, such as strokes or heart attacks. These effects are presumably due to the wide fluctuations in the blood pressure and heart rate that occur during treatment. The fluctuations result from the rapid onset and short duration of the short-acting compounds. When the calcium channel blockers are used in sustained release preparations, however, less fluctuation occurs. Accordingly, the sustained release forms of calcium channel blockers are probably safe for long-term use. The main side effects of these drugs include constipation, swelling (edema), and a slow heart rate (only with the non-dihydropyridine types).

Angiotensin-converting enzyme (ACE) inhibitors and ACE receptor blockers (ARBs)
ACE inhibitors stop the production or block the action of a chemical called angiotensin II, a very potent chemical that causes blood vessels to contract, a cause of high blood pressure. Blockage of this chemical causes the blood vessels to relax. ACE inhibitors include Captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril, Prinivil), quinapril (Accupril), fosinopril (Monopril). ARBs include losartan (Cozaar), candesartan (Atacand), valsartan (Diovan), irbesartan (Avapro), olmesartan (Benicar). Side effects are infrequent but sometimes they can worsen kidney function. ACE inhibitors sometimes cause dry cough. ARBs usually have fewer side effects.

Alpha-blockers

Alpha-blockers relax blood vessels by blocking messages from the nervous system that cause muscular contraction. Alpha-blockers lower blood pressure by blocking alpha-receptors in the smooth muscle of peripheral arteries throughout the tissues of the body. The alpha-receptors are part of the sympathetic nervous system, as are the beta-receptors. The alpha-receptors, however, serve to narrow (constrict) the peripheral arteries. Accordingly, the alpha-blockers cause the peripheral arteries to widen (dilate) and thereby lower the blood pressure.

Recent evidence, however, suggests that using alpha-blockers alone as a first line drug choice for hypertension may actually increase the risk of heart-related problems, such as heart attacks or strokes. Alpha-blockers, therefore, should not be used as an initial drug choice for the treatment of high blood pressure. Examples of alpha-blockers include terazosin (Hytrin) and doxazosin (Cardura).

Alpha-blockers are particularly useful in patients with enlargement of the prostate gland (which usually occurs in older men) because these drugs reduce the problems associated with urinating. Alpha-blockers alone, however, have a relatively small blood pressure-lowering effect. Accordingly, when hypertension coexists with prostatic enlargement, another anti-hypertensive medication should be used together with an alpha-blocker. For example, tamsulosin (Flomax) is an alpha-blocker that works well in combination with other anti-hypertensive medications. Such a combination can relieve urinating problems without causing an excessive decrease in the blood pressure.

Blockers of central sympathetic (autonomic nervous) system

These agents block messages from the autonomic nervous system that contract blood vessels. The autonomic nervous system is the part of the nervous system that is automatic and controls heart rate, breathing rate, and other basic functions. Their effect is to relax blood vessels, thus lowering blood pressure.

More information on high blood pressure

What is blood pressure? - Blood pressure or arterial blood pressure is the pressure (force per unit area) exerted by the blood on the walls of the blood vessels.
What is high blood pressure (hypertension)? - High blood pressure or hypertension means high pressure (tension) in the arteries. High blood pressure is generally defined as a level exceeding 140/90 mm Hg that has been confirmed on multiple occasions.
How to measure blood pressure? - Arterial blood pressure is usually measured in millimeters of mercury (mm Hg) using a sphygmomanometer.
What causes high blood pressure? - High blood pressure is far more common in families where other members have this condition. There are also many other factors which are related to high blood pressure.
At what level is blood pressure too high? - Blood pressure is generally felt to be abnormally high at a level of 140/90, and some sort of definitive therapy and follow-up should be started at this level.
What is "white coat syndrome"? - "White coat syndrome" is a situation where patients have high blood pressure in the doctor's office but nowhere else.
What're the symptoms of high blood pressure? - High blood pressure usually causes no symptoms. Sometimes people with high blood pressure have symptoms including headache, dizziness, blurred vision and nausea.
How is high blood pressure diagnosed? - The diagnosis of high blood pressure is made on the basis of many blood pressure readings. It is diagnosed if several readings show a systolic blood pressure greater than 140 or a diastolic blood pressure greater than 90.
What is isolated systolic hypertension? - Isolated systolic hypertension (ISH) is defined as elevated systolic blood pressure in conjunction with normal diastolic blood pressure (<90 mm Hg).
Why and how isolated systolic hypertension (ISH ) develops? - Factors that may play a role in the high prevalence of ISH seen in Western societies include increased body fat, sedentary lifestyle, and increased sodium intake.
What is white coat hypertension? - White coat hypertension should be considered when blood pressure readings are significantly elevated in the absence of target-organ damage.
What is borderline hypertension? - Borderline hypertension is a blood pressure level which is in the 'gray zone' between normal and high (for example, someone with an average pressure of about 140/90 mmHg).
What is malignant hypertension (arteriolar nephrosclerosis)? - Malignant hypertension is an acute emergency requiring immediate treatment in hospital.
What is labile hypertension? - 'Labile' means variable, and just about everyone with hypertension has 'lablie hypertension.'
What is pulmonary hypertension? - Pulmonary hypertension is high blood pressure in the pulmonary circulation (the arteries which go to the lungs). The blood pressure in the arms and the rest of the body is normal or low.
What is renovascular hypertension? - Renovascular hypertension is a secondary form of high blood pressure caused by a narrowing of the renal artery.
What're the risk factors for high blood pressure? - Controllable factors contribute to high blood pressure include sodium (salt) sensitivity, obesity and overweight, heavy alcohol consumption, use of oral contraceptives and some other medications, and sedentary or inactive lifestyle.
What're the complications of high blood pressure? - Blood vessels can narrow due to high blood pressure and the accumulation of cholesterol. Blockage of arteries in the brain can lead to stroke. Blockage of blood vessels in the kidneys can lead to kidney failure.
How does body weight affect hypertension? - Studies have shown that body weight, changes in body weight over time, and skinfold thickness are related to changes in blood pressure levels.
What're the treatment options for high blood pressure? - The goal of treatment is to reduce blood pressure to a level where there is decreased risk of complications. Treatment may occur at home with close supervision by the health care provider, or may occur in the hospital.
What medications are available for high blood pressure? - Medications may include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or alpha blockers.
Which lifestyle modifications are beneficial in treating hypertension? - Lifestyle modifications refer to certain specific recommendations for changes in diet and exercise.
What is a good high blood pressure diet? - A good high blood pressure diet is not only rich in important nutrients and fiber but also includes foods that contain far more electrolytes, potassium, calcium, and magnesium, than are found in the average American diet.
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High-Rite supports the healthy functioning of the cardiovascular system, thereby helping to maintain balanced pressure of the blood on veins and arteries, routine oxygenation of the blood to the heart muscle and pulse regulation.

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