Issue of January 7, 2018

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Every Juan is unique

What is good for one hypertensive patient may not necessarily be good for another patient. Before a doctor prescribes a drug for your blood pressure, he/she will consider several factors, which include the following:

Your comorbid conditions. Aside from high blood pressure, do you also suffer from asthma, diabetes, thyroid disease, cancer, kidney disease, anxiety disorder, anemia or other illnesses? Presence of other illnesses will limit your doctor’s choice of antihypertensive drugs so it is best to provide all information to your doctor.

Your past medical history. For example, did you have stroke in the past?

Your doctor will choose drugs that, aside from controlling your blood pressure, will also protect you from stroke recurrence.

What are your other antihypertensive medications? Complementary actions and safe combinations of drugs will be considered.

What are your other medications for other illnesses? Are you on non-steroidal pain relievers like Celecoxib, Mefenamic Acid, and Diclofenac? Especially when used for a long period, combination of these drugs with angiotensin II blockers and ACE inhibitors can cause acute kidney injury.

Your age. Drugs that rapidly lower blood pressure may not be prescribed to elders.

Your heart rate. If your heartbeat is less than 80 per minute then drugs like beta-blockers, Diltiazem, and Clonidine are avoided.

Presence of albumin or protein in the urine.


Anti-hypertensive medications differ in terms of site of action, duration of action, side effects, drug interactions, and additional protective effects. Listed below are drugs commonly used to control blood pressure.

Diuretics – include Thiazide or Thiazide-type drugs, Furosemide, Bumetanide, Spironolactone, Amiloride. They control blood pressure by promoting diuresis or loss of body water through the urine. Blood sodium, potassium levels may decrease or increase. It may cause elevation of blood uric acid level.

ACE Inhibitors – Captopril, Enalapril, Lisinopril, Perindopril, Ramipril. Cough is a common side effect. These are not combined with angiotensin II blockers or Aliskerin. It can increase risk for elevation of potassium in the blood. These are avoided in pregnancy.

Angiotensin II blockers – Losartan, Candesartan, Irbesartan, Telmisartan, Valsartan. Not combined with ACE inhibitors or aliskerin. It can increase risk of blood potassium elevation in patients with chronic kidney disease, in patients using potassium-sparing drugs, or on potassium supplements. Cough is common side effect but less compared to ACE inhibitors. These drugs are avoided in pregnancy.

Calcium channel blockers – classified as either dihydropyridines or non-dihydropyridines based on chemical structure.

Dihydropyridines – Amlodipine, Felodipine, Isradipine, Nicardipine, Nifedipine Sustained-Release, Nifedipine Long-Acting. Use is avoided in patients with heart failure with reduced ejection fraction. If use is required, your doctor will choose Amlodipine or Felodipine. These drugs can cause dose-related swelling of the feet/legs (pedal edema) which is more common in women than in men. This leg swelling is due to dilatation of blood vessels and is not due to kidney, liver or heart failure. It is not managed with the use of diuretics.

Non-dihydropyridines – Diltiazem, Verapamil. Use with beta-blockers or clonidine is generally avoided due to increased risk of reduced heart rate and risk of heart block. Not used in patients with heart failure with reduced ejection fraction.

Beta-blockers – Atenolol, Betaxolol, metoprolol, nebivolol, propranolol. These can slow down heart rate. Sudden cessation of use can lead to rebound hypertension.

Direct renin inhibitor – It has long duration of action and is avoided in pregnancy.

Alpha-1 blockers – Doxazocin, Prazosin, Terazosin. In older patients these can cause hypotension upon standing up hence avoided. Good second-line choice in patients with benign prostate enlargement.

Central alpha-1 agonist and other centrally acting agents – Clonidine oral and patch. Methyldopa, Guanfacine. Reserved as last-line choice especially in older adults due to adverse effects that may involve the central nervous system (the brain).

Direct vasodilators: Hydralazine, Minoxidil. Can cause retention of sodium/salt and water in the body. May cause increase in heart rate.

Your doctor on a regular basis will do adjustments in the dose of your antihypertensive medications. Individualized treatment is done. Your own unique medical history and response to the drugs will be considered. If your blood pressure is difficult to control, drug dose may be increased, other drugs will be added. Prescription of pills with combination of two to three drugs may be done to increase your compliance, a problem that is commonly encountered in blood pressure management.

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Medical questions and concerns may be emailed to or Answers will be emailed directly or will be provided in the paper’s next issue.

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