As I said in my last blog post, this week I thought I might
go over the most common medications to treat blood pressure. The algorithm to the left is one of many that physicians use to decide what medications- if any- to use. To make all these drugs easier
to understand, I will break them up into categories (classes). Your doctor will
take into account not only the extent of your high blood pressure, but your
other conditions as well. For example, if you have diabetes as well, they will
most likely start with an ACE inhibitor or ARB for their protective effects to
the kidney. This is by no means an exhaustive list, but it will be a great
overview so you will understand your medication better.
The “pril’s” – These drugs commonly end in ‘pril’ like
lisinopril, benazepril, or enalapril. For those wanting the technical term they
are the ACE inhibitors. Very common drug as a first line agent as it is cost
effective (lisinopril is a $4 medication for 30 tablets) and easy to take (once
daily dosing to start). I won’t give you an exhaustive list of side effects,
but commonly causes dizziness (all blood pressure lowering medications do), and
sometimes an annoying tickle in the throat that makes you cough. The dizziness
should go away as your body gets used to your new blood pressure, but if you
get the dry cough, that won’t disappear so easily. The next medications work
very similarly, but do not cause a cough.
The “sartan’s” – Examples include losartan, valsartan
(Diovan®), and irbesartan. Technical term is the ARBs. These medications are
more expensive because they are newer, but they do not cause that annoying
cough. Some insurances will want you to try an ACE inhibitor first too because
of cost so be aware. The cheapest is the losartan of these medications.
The “water pills” – Named for their ability to remove water
from your body which causes that need to go to the bathroom often. Examples
include furosemide (Lasix®), spironolactone (Aldactone®), and hydrochlorothiazide
(HCTZ). These medications have multiple subclasses, but I lumped them together
to reduce confusion. Lasix is probably the one of the strongest ones of the
bunch, but it is commonly used. Aldactone® – in addition to causing you to
urinate more often – can also cause breast enlargement and other hormonal
problems in some cases. HCTZ is more common than Lasix, but not quite as
strong. It is also one of the first line agents used when first diagnosed. It
is pretty important to take these medications in the morning or early afternoon
because they will have you going to the bathroom more often; it is no fun to be
getting up all night because you took your medication late in the day. Lasix
and HCTZ are both $4 for 30 tablets.
The “olol’s” – examples of these are metoprolol, labetalol,
and carvedilol. These are the Beta Blockers. Very well studied drug and also a
good first line agent. These are also commonly given twice daily, or there is
an extended-release product of metoprolol that is more expensive and is given
once-daily. Labetalol can be used in pregnant women for blood pressure and the
class of drugs has been well studied in heart failure patients. These also have
some $4 medications for 60 tablets.
When it comes to choosing a blood pressure medication, I
would tell patients to try the generics out first just for the fact that they
have more studies on them, and to lessen the cost burden on both you and
healthcare costs as a country. There are very few novel drugs coming out for
blood pressure at this time, and most of the new drugs are what we like to call
“me-2” drugs. This means that they are just adding to a list in a particular
class that is already out on the market. Bystolic®, for example, is adding to
the class of Beta Blockers. Not to say that these new ones out are less useful,
but if it were me, I would try metoprolol or carvedilol first.
If you have questions about your blood pressure medications
or are looking for other options, contact your local pharmacist for suggestions
to ask your doctor about. The pharmacist is much more readily available to talk
to, and we give out free advice just because we love helping our patients!
Does anyone have any questions about a specific medication?
I would love to help!
