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Choosing Your Blood Pressure Medication: What Type Is Best for You?

by Dr. Sharon Orrange on January 31, 2017 at 3:46 pm

High blood pressure is a key risk factor for stroke and heart disease, but it is easy to treat! If you have tried lifestyle changes and your blood pressures is still greater than 140/90, your doctor may discuss starting a medication to lower your pressure. If this is the case, it might be difficult to decide on which blood pressure medication is best for you. However, it turns out this question has been well studied, and the answer partly depends on your age and race.

Here is what you need to know if you are starting a medication for high blood pressure.

Younger people with high blood pressure (20-50 year olds):

  • Start here. ACE Inhibitors, or angiotensin receptor blockers (ARBs), are recommended as first line therapy because they lower blood pressure and the risk of stroke and heart disease. ACE inhibitors are cheap, well tolerated medications that end in -il (for example: lisinopril, enalapril, benazepril). ARBs are very similar to ACE inhibitors but do not carry the dry cough side-effect that ACE inhibitors have. Common ARBs are losartan, irbesartan and valsartan.
  • Another option. Beta blockers are a second option for younger patients who can’t take ACE inhibitors or ARBs, as some studies show that they don’t provide the same protection against stroke risk. Commonly used beta blockers include atenolol, metoprolol and carvedilol.
  • Final notes. Studies show improved blood pressure in patients taking the above options rather than diuretics (chlorthalidone, hydrochlorothiazide) and calcium channel blockers.

African Americans:

African American patients with high blood pressure have lower levels of renin activity, a hormone that controls blood pressure. For this reason ACE Inhibitors and ARBs are not as effective.

  • Start here. Thiazide diuretics (hydrochlorothiazide, chlorthalidone) are suggested as a first line treatment. Chlorthalidone is preferred over hydrochlorothiazide as there is more evidence of improved outcomes and it is more potent and longer acting. Both are safe, effective, well tolerated, and cheap.
  • Another option. Calcium channel blockers, namely amlodipine (Norvasc), or the less often prescribed felodipine, are also recommended as first choice to control blood pressure, specifically in African Americans.

People over 60-65 years old:

  • Start here. According to many studies, thiazide diuretics (hydrochlorothiazide, chlorthalidone) and calcium channel blockers (amlodipine) are the place to start.
  • Another option. ACE inhibitors (lisinopril, benazepril, etc) or ARBs (valsartan, irbesartan, losartan) are also recommended as a good place to start.
  • Final notes. Studies have shown that beta blockers should not be used as first line therapy for high blood pressure in patients over the age of 60, as they may be associated with inferior protection against stroke risk.

Folks with REALLY high blood pressure (approximately 160/90 and above):

  • Start here. Combination medications (two drugs) as an initial therapy should be considered when the blood pressure is more than 20/10 mmHg above goal. Many combinations exist, so discuss the options with your doctor.

What about patients with heart failure, diabetes, or heart attack?

For people with diabetes, heart failure, and those who have had a heart attack, blood pressure medications are added to lower blood pressure and also improve outcomes. Simply put, beta blockers, ACE inhibitors and ARBs improve outcomes in people after a heart attack and in those with diabetes or heart failure.

Dr. O


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