I personally know many hypertensive patients who skip the medicine intake for one or two months just to stay away from it’s “dangerous side effects”.
“I’ve heard and read a lot about the side effects of these medicines, is there any way around?” is another common question that I face at the out patient department from patients who have been advised to start anti-hypertensive medicines.
Medicines aren’t the only way to treat high blood pressure though! It’s actually the easy way. The tough method is to change your lifestyle, reducing the salt content in your diet, eat and drink healthy, do some physical activity and staying away from alcohol and cigarettes.
So, here I am writing this post to help the already anxious hypertensive patients to understand the basic facts and the “side effects” of some of the most commonly used medicines used to treat hypertension.
Meet the Medicines and their Family
Angiotensin Converting Enzyme (ACE) Inhibitors work by blocking the renin angiotensin mechanism thereby relaxing the blood vessels and decreasing the blood volume load. It’s one of the most commonly used first-line anti-hypertensives out there and are also used in congestive heart failures, chronic kidney diseases and so on.
Common examples of ACE inhibitors are enalapril, lisinopril, ramipril, perindopril and captopril
Angiotensin-2 Receptor Blockers (ARB) acts in a similar way to ACE inhibitors, the only difference is that they directly block the Angiotensin-2 receptors in the renin angiotensin mechanism. ARBs are usually given when ACE inhibitors doesn’t work as expected. Along with hypertension, ARBs are also used in cardiac failure and diabetic nephropathy.
Common ARBs used are losartan, telmesartan, candesartan, irbesartan and olmesartan
Calcium Channel Blockers (CCB) block the movement of calcium ions through calcium channels and relaxes stiff blood vessels thereby lowering blood pressure. It’s particularly effective in elderly hypertensive patients and is easily one of the most prescribed in government hospitals. They are also used in heart failures.
Amlodipine, nifedipine, felodipine, diltiazem and verapamil are some of the common CCBs
Diuretics acts by flushing out excess water and salts in our body through urine. They are used when CCBs causes troublesome adverse effects. The main role of these “water-pills” is in treating heart failure, liver cirrhosis, water intoxication etc.
Common examples are indapamide, bendroflumethiazide, hydrochlorthiazide, furosemide, toresemide
Beta Blockers work by making your heart beat slowly and with less force. It was very widely used as an anti-hypertensive until recently when studies showed that they were actually less effective than the other groups of medicines. They are now used when all other types of medicines fail.
Atenolol and bisoprolol are common examples of beta blockers.
The Right Way
Take your medicines as prescribed by your Doctor. You most probably won’t feel any change in the first few weeks, but trust “science” and continue taking it at the right time ever day and let the drug do it’s job.
Commonly, the above mentioned medicines are prescribed as combinations to effectively lower your blood pressure. No, your doctor is not trying to kill you by overdosing!
If you’ve been started on any medicines, it’s because that you’re most likely to develop other complications of high blood pressure like heart attacks, stroke, kidney failure. Keep in mind that the medicines along with lifestyle changes are absolutely needed for your good health in the future.
It’s okay if you miss one or max two doses unintentionally. You don’t have to take the missed tablet along with the next dose.
You’ll have to take the medicines for the rest of your life. But, your doctor might also be able to reduce the dose or even stop it if your blood pressure is under control for a long time. So, be righteous and honest with your doctor.
Lifestyle changes are also necessary along with medicines. Try to avoid salted food items, alcohol, cigarettes, colas and pickles. Feel fresh with a tinge of good aerobic workouts every day.
Some persons (not all) might experience side effects and when you do, just tell your doctor. Most often, changing the medicines will be enough.
Monitoring your blood pressure at home or at hospital is crucial. Make use of the digital blood pressure meters and record the readings in a notebook. Confused on which type of blood pressure meters to buy? Have a look at this guide and our top picks here.
The Wrong Way
Taking your medicines on alternate days to reduce the side effects is insane! The medicines, unless prescribed as such, doesn’t work that way. I know patients who regularly take medicines for one week or one month and then stop taking it for the next week or month, just to experiment with their blood pressure variations. Don’t do that!
There are other patients who take twice the prescribed dose of medicine, so that they can eat pickles and spicy biriyanis from the local popular restaurant. That’s not advisable!
Don’t think that taking these medicines for a long time will adversely affect your kidneys or other organs. The real danger is when your blood pressure remains uncontrolled. It’s then when your kidneys, heart and brain becomes the most vulnerable.
The medicines are not meant to be taken only when you feel a headache or dizziness which you assume could be due to sudden rise in blood pressure. It has to be taken daily as prescribed.
Do not titrate the dosage by adding or reducing half a tablet as and when you like it without consulting your doctor.
The Side Effects
Kindly note that only a small fraction of patients experience side effects due to these medicines and most of these symptoms can be nullified by simply changing the medication. All side effects of a particular family of medicines vary considerably and they doesn’t come as a package!
ACE Inhibitors: Persistent dry cough, headache, dizziness, rash
Angiotensin Receptor Blockers: Flu like symptoms, headache, dizziness
Calcium Channel Blockers: Ankle swelling, constipation, headache (stay away from grape juice)
Diuretics: Dizziness on standing up from sitting position, increased thirst and increased frequency of urination, low sodium and potassium levels after long term use (cautious use in diabetic hypertensives)
Beta Blockers: slow heart beats, cold hand and feet, dizziness (not suitable for asthmatics)
There you have it. That’s all the basics you need to know while taking anti-hypertensive medicines. If you’ve any questions, use the comments section below. You can also shoot your queries on twitter or via email.