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There are many medication combinations that can help you get your blood pressure to your target normal. The treatments should be individualized - there is no standard formula.
Everyone responds to antihypertensive medications differently because biochemistry and other factors vary widely from person to person. So the hypertension drugs that are working so well for your best friend may not work for you. Fortunately, there are scores of antihypertensive agents available today, and your physician can explore many different options in tailoring a treatment to your individual needs.
Keep in mind that your doctor may have you try a number of different medications before finding the best regimen for you. If a single antihypertensive drug does not reduce your blood pressure to normal levels, your doctor may increase your dosage or try a combination therapy, adding additional medications until your blood pressure is under control.
The goal of combination therapy is to use smaller amounts of one or more agents in combination to minimize side effects while maximizing the antihypertensive effect. Diuretics, for instance, are often used in low doses in combination with an antihypertensive drug from a different class. When the two are combined, the diuretic causes fewer side effects while improving the blood pressure-lowering effect of the other drug.
According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), "Most patients who are hypertensive will require two or more antihypertensive medications to achieve their blood pressure goals. Addition of a second drug from a different class should be initiated when use of a single drug in adequate doses fails to achieve the blood pressure goal." The report, published by the National Heart, Lung, and Blood Institute (NHLBI) also notes that therapy with more than one drug may increase the likelihood of reaching blood pressure goals more quickly. Click here to read the key-points version of the report JNC 7 Express.
Remember take as directed.
Forgetting to take your medications compromises your therapy and puts you at risk. If remembering your meds is a problem for you, check out Tips to Help You Remember to Take Your Blood Pressure Drugs from the National Heart, Lung, and Blood Institute.
Treating Hypertension with Drug Therapy
| Classification and Management of Blood Pressure for Adults* |
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Initial Drug Therapy |
| BP classification |
SBP* (mm Hg) |
DBP* (mm Hg) |
Lifestyle modification |
Without compelling indications |
With compelling indications (see table 2) |
| Normal |
< 120 |
and < 80 |
Encourage |
No antihypertensive drug indicated |
Drug(s) for compelling indications** |
| Pre-hypertension |
120-139 |
or 80-89 |
Yes |
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| Stage 1 hypertension |
140-159 |
or 90-99 |
Yes |
Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination |
Drug(s) for the compelling indications.** Other antihypertensive drugs diuretics (ACEI, ARB, BB, CCB), as needed |
| Stage 2 hypertension |
Greater than or equal to 160 |
Or greater than or equal to 100 |
Yes |
Two-drug combination or most*** (usually thiazide-type diuretic and ACEI or ARB or BB or CCB) |
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BP, blood pressure; SBP, systolic BP; DBP, diastolic BP; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, b-blocker; CCB, calcium channel blocker.
* Treatment determined by highest BP category.
** Treat patients with chronic kidney disease or diabetes to BP goal of < 130/80 mm Hg.
*** Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension.
Source: JNC 7 Express. |
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