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Medication

Doctors usually prescribe antihypertensive medication when high blood pressure cannot be controlled with lifestyle changes. Most people who take antihypertensive medication need to take it for the rest of their life.

The following list provides a brief description of the most frequently prescribed types of antihypertensive medications. (For additional information about these medications, see page 562.)

Blood Pressure Classifications for People Age 18 or Older

Category Systolic Diastolic

Normal blood pressure Lower than 120 mm Hg Lower than 80 mm Hg

Prehypertension 120 to 139 mm Hg 80 to 89 mm Hg

Stage 1 hypertension 140 to 159 mm Hg 90 to 99 mm Hg

Stage 2 hypertension 160 mm Hg or higher 100 mm Hg or higher

A diagnosis of hypertension is based on two or more blood pressure readings taken at separate visits to the doctor’s office or clinic. If your systolic pressure falls into one category and your diastolic pressure into another, the higher reading is used to classify your blood pressure.

• Diuretics Diuretics increase the kidneys’ excretion of water and sodium, reducing the volume of blood the heart has to pump, thereby reducing blood pressure.

• Beta blockers Beta blockers slow the heart rate and block the output of an enzyme that raises blood pressure.

• Alpha blockers Alpha blockers prevent arteries from constricting and block the effects of the stress hormone epinephrine, which raises blood pressure.

• ACE inhibitors ACE (angiotensin-converting enzyme) inhibitors block production of an enzyme (ACE) that causes blood vessels to constrict.

• Angiotensin-receptor blockers Angiotensin-receptor blockers prevent the arteries from constricting and prevent the kidneys from retaining sodium and water, which can raise blood pressure.

• Centrally acting drugs Centrally acting drugs work directly on the brain and nervous system to prevent arteries from constricting, lowering heart rate and blood pressure.

• Calcium channel blockers Calcium channel blockers prevent the smooth muscle of the artery walls from contracting and narrowing the blood vessels; calcium channel blockers may also slow or block the development of plaque, which can build up on artery walls and narrow them.

WARNING!

Sudden, Rapid Drop in Blood Pressure

Hypotension is the medical term for low blood pressure. Postural hypotension is a rapid drop in blood pressure that occurs when you sit up or stand too quickly. When you change position suddenly, your body usually makes a quick adjustment in blood pressure. But in postural hypotension, your blood pressure falls and blood flow to your brain is temporarily reduced, causing dizziness and sometimes fainting.

Postural hypotension may be a side effect of antihypertensive medication. Occasionally, postural hypotension occurs during pregnancy or as a symptom of a disease or condition such as diabetes (see page 889), atherosclerosis (see page 557), Addison’s disease (see page 899), or dehydration.

If you often feel dizzy or faint when getting up from a sitting or lying position, try to move more slowly. If this does not help, talk to your doctor. If you are taking antihypertensive medication, he or she will probably adjust the dosage or prescribe a different drug. If this does not relieve your symptoms, you may need to have a physical examination and tests to determine the underlying cause of the problem.

Checking Your Blood Pressure at Home

Your doctor will probably recommend that you check your blood pressure at home with a home blood pressure monitor. Both mechanical and electronic blood pressure monitors are available at drugstores and medical supply companies. Ask your doctor which type of monitor you should buy.

A home blood pressure kit should include an easy-to-read pressure gauge, cuffs in various sizes, a stethoscope (for mechanical monitors), and easy-to-understand instructions. Your doctor or a nurse can teach you how to use the monitor correctly.

The following guidelines will help you take an accurate reading