Wondering about high blood pressure meds? Start by learning the ABCDs

If you’re concerned about your blood pressure (and most people in the Western world should be), then it’s good to have some understanding of the potential treatments that doctors can prescribe. Fortunately, it’s fairly easy to understand the basics, because it’s as simple as ABCD. These are the starting letters of the four basic classes of drugs (antihypertensives) that are most often used today – ACE inhibitors and ARBs, Beta-blockers, Calcium channel blockers, and Diuretics.

Sidebar: Fundamentals of HBP

High blood pressure, often referred to as HBP, is called hypertension in clinical terms. It can be a nasty condition, mostly because it develops slowly and quietly. That’s why it is often referred to as a “silent killer,” usually because no symptoms are noticed until it triggers a response in a vital organ – usually the heart or the brain. Some of the potential outcomes of untreated HBP are very serious, even life threatening – heart attack, stroke, even sudden death. There’s also no simple cure for the condition. The best advice healthcare providers can give is to keep blood pressure under control, and to never let it slip off the attention radar.

The key classes of antihypertensives

• ACE Inhibitors  and ARBs
  • ACE (Angiotensin-Converting Enzyme) inhibitors relax blood vessels by preventing the formation of a hormone that narrows them.
  • ARBs (Angiotensin II Receptor Blockers) work similarly to ACE inhibitors, but they block the action of the hormone rather than its production.
• Beta-blockers: Reduce heart rate and the force of the heart’s contractionCalcium Channel Blockers (CCBs) prevent calcium from entering heart and vessel muscles, allowing vessels to relax
• Diuretics, sometimes called water pills, help the kidneys eliminate excess sodium and water, reducing blood volume.

There are a few other classes that are fall-back (second-choice) options for doctors, usually when the ABCDs are not producing an adequate relief of BP in specific cases. The preferred, or first-line, treatments are (in no specific order) diuretics (especially thiazide-type), ACE inhibitors, ARBs, and Calcium channel blockers. Beta-blockers have fallen out of favor, not because they don’t work, but mainly because the other choices are more efficient and have fewer side effects. It’s also not unusual for doctors to prescribe some form of combination therapy. Many patients require two or more medications to reach target blood pressure levels. The optimum therapeutic choice depends on factors such as the patient’s age, gender, genetics, and co-existing conditions such as heart failure, diabetes.

Hypertension Treatment Comparison Tables

Comparison table – first choice is ABCD

Comparison table – Alternative treatments

Glossary