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Understanding your treatment - high blood pressure

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You may be prescribed drugs to help lower your blood pressure

If you have high blood pressure your treatment may involve:

You doctor will take into account how high your blood pressure is as well as your ethnic origin, your general fitness, your age and any other medical conditions you might have before deciding what treatment is best for you. Questions you may have about your treatment can include:

When will I start treatment?

When to start treatment with blood pressure lowering drugs will again depend upon your individual situation.

  • Sometimes you may need to start treatment straight away, e.g. if your blood pressure measurement is 180/100mmHg or greater. You may also be referred to a specialist.
  • You may be asked to monitor your blood pressure at home to confirm a diagnosis. Your doctor will consider these readings as well as your general health and if you have any damage (from high blood pressure) throughout your body. Sometimes your doctor may want to see what effect lifestyle changes have on your blood pressure before starting drug treatment.
  • If you are under 40 years old and you do not have cardiovascular disease, kidney disease or diabetes then you may be referred to a specialist to see if there is another cause of your high blood pressure.

It is essential to try making some lifestyle changes and to maintain these changes even if you have to take drugs to lower your blood pressure.

What are the aims of drug treatment?

  • The aim is to reduce your blood pressure to an agreed 'target range' and to keep it as close to this target range as possible.
  • It is likely that you will have to continue with your treatment in order to keep your blood pressure well-controlled. If you stop taking your drugs your blood pressure may quickly rise again.

If your doctor has suggested ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to monitor your response to treatment then lower target ranges may be used. This is because blood pressure readings tend to be slightly lower at home / away from the clinic.

Sometimes it is not possible to reach your target range. However, any reduction in high blood pressure helps to reduce your risk of heart disease and stroke.

How do blood pressure lowering drugs work?

There are different groups of drugs that are used to treat high blood pressure; each works in a different way. Generally, they work by manipulating your body's own mechanisms for controlling the blood flow to the different organs in your body. The end result is that they widen your blood vessels and / or reduce the work of your heart.

More specifically, they work on your brain, kidneys, heart or arteries, all of which are involved in regulating your blood pressure.

How will my doctor choose the right drug for me?

It is likely you may have to take more than one group of blood pressure lowering drugs. Your doctor will choose the best combination for you depending on your individual situation and how well your blood pressure responds to treatment. Your treatment may involve a combination of two, or more, of the following groups of drugs to lower your blood pressure:

  • ACE inhibitors (Angiotensin Converting Enzyme inhibitors)
  • ARBs (Angiotensin II receptor blockers): these are mainly used when ACE inhibitors are not suitable, e.g. due to side effects.
  • Calcium channel blockers
  • Diuretics ('water' tablets): usually a 'thiazide' diuretic will be used, e.g. bendroflumethiazide.
  • Alpha blockers
  • Beta blockers: latest evidence shows that, due to side effects, these should no longer be considered as routine first treatment for high blood pressure. If you have been taking beta blockers for some time your doctor may discuss reviewing your treatment. Do not stop taking them without discussing with your doctor.

The following drugs may also be prescribed to help reduce the risk of further problems with your heart:

  • Antiplatelets: this is usually aspirin.
  • Statins

More information on all the different drugs can be found in the heart drug treatment page.

Choosing the best combination of drugs

It is very common to need a combination of two, or more, drugs to reduce your blood pressure to the within the target range. One of the benefits of taking a combination of blood pressure lowering drugs is that you are likely to need lower doses of each drug and will have fewer side effects.

The British Hypertension Society (BHS) have worked with the National Institute for Health and Clinical Excellence (NICE) to produce guidelines for the management of high blood pressure. What combination you receive will depend upon your individual circumstances (particularly your age and ethnic origin). Your doctor and / or nurse may go through a number of well-recognised steps before finding the best combination for you.

The following table outlines current recommendations for choosing blood pressure lowering drugs. This is often known as the 'A / CD' approach.

  • Note: if you are black of African or Caribbean descent then you should start treatment with calcium channel blockers regardless of what age you are.

 The A / CD approach for people with newly diagnosed hypertension

Younger than 55 years old 55 years old and older OR people of African* or Caribbean origin
STEP 1 A C
STEP 2 A + C A + C
STEP 3 A + C + D A + C + D
STEP 4 Add:

  • further diuretic
  • or alpha blocker
  • or beta blocker

Consider seeking specialist advice

Add :

  • further diuretic 
  • or alpha blocker
  • or beta blocker

Consider seeking specialist advice

A = ACE inhibitor (or ARB) C = calcium channel blocker D = thiazide diuretic

* Black African or Caribbean descent and not mixed race, Asian or Chinese origin

  • Note: The above table was updated in 2011. If your treatment started before 2011 you may be on a different regime.
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