DEFINITION OF HYPERTENSION:

*Hypertension or (high blood pressure),sometimes called "arterial hypertension", is

a chronic medical condition in which the blood pressure in the arteries is elevated to
an extent that clinical benefit is obtained from blood pressure lowering.
*Blood pressure is summarised by two measurements, systolic and diastolic, which
depend on whether the heart muscle is contracting (systole) or relaxed between
beats (diastole) and equate to a maximum and minimum pressure, respectively.
Normal blood pressure at rest is within the range of 100-140mmHg systolic (top
reading) and 60-90mmHg diastolic (bottom reading). High blood pressure is said to
be present if it is persistently at or above 140/90 mmHg.
CARDIOVASCULAR COMPLICATION ASSOCIATED WITH HYPERTENSION:
The most common and important of these are:
Myocardial infarction
Stroke
- Cerebral/brain stem infarction
- Cerebral haemmorhage
- Lacunar syndromes
- Multi-infarct disease
Hypertensive encephalopathy/malignant hypertension
Dissecting aortic aneurysm
Hypertensive nephrosclerosis
Peripheral vascular disease
The risk of heart failure is increased six-fold in hypertensive subjects. Meta-analysis
of clinical trials has indicated that these risk are reversible with relatively modest
reductions in blood pressure of 10/6mmHg associated with a 38% reduction in
stroke and 16% reduction in coronary events, while a 5mmHg reduction in blood
pressure is associated with a 25% reduction in risk of renal failure.
EPIDEMIOLOGY OF HYPERTENSION:
* Essential hypertension (primary hypertension)
* Secondary hypertension
Essential hypertension (also called primary hypertension or idiopathic hypertension)
is the form of hypertension that by definition has no identifiable cause. It is the
most common type of hypertension, affecting 95% of hypertensive patients,it tends
to be familial and is likely to be the consequence of an interaction between
environmental and genetic factors.Genetic factors clearly play a part as the
condition clusters in families, with hypertension being twice as common in subjects
who have a hypertensive parent.
Prevalence of essential hypertension increases with age, and individuals with
relatively high blood pressure at younger ages are at increased risk for the

subsequent development of hypertension. Hypertension can increase the risk of

cerebral, cardiac, and renal events.
Secondary hypertension (secondary high blood pressure) is high blood pressure
that's caused by another medical condition. Secondary hypertension differs from
the usual type of high blood pressure (essential hypertension), which is often
referred to simply as high blood pressure.
Secondary hypertension can be caused by conditions that affect:

Kidneys (renal disease)

Heart
Endocrine system
- steroid excess:hyperaldosteronism(Conn's syndrome)
- hyperglucocorticoidism(cushing's syndrome)
- growth hormone excess:acromegaly
- catecholamine excess:phaeochromocytoma

Secondary hypertension can also occur during pregnancy:pre-eclampsia

Vascular causes
- Renal
artery
stenosis:fibromuscular
hyperplasia;renal
atheroma;coarction of the aorta

artery

Drugs
- Sympathomimetic amines
- Oestrogens (e.g. combined oral contraceptives pills)
- Cyclosporin
- Erythropoietin
- NSAIDs
- Steroids

Proper treatment of secondary hypertension can often control both the underlying
condition and the high blood pressure, which reduces the risk of serious
complications including heart disease, kidney failure and stroke.
Hypertension is more common in black people of African Caribbean origin, who are
also at particular risk of stroke andrenal failure. Hypertension is exacerbated by
other factors, for example high salt or alcohol intake, poor diet, lack of exercise and
obesity.
REGUALTION OF BLOOD PRESSURE:
The endogenous regulation of arterial pressure is not completely understood, but
the following mechanisms of regulating arterial pressure have been wellcharacterized:

Baroreceptor reflex: Baroreceptors in the high pressure receptor zones detect

changes in arterial pressure. These baroreceptors send signals ultimately to
the medulla of the brain stem, specifically to the Rostral ventrolateral
medulla (RVLM). The medulla, by way of the autonomic nervous system,

adjusts the mean arterial pressure by altering both the force and speed of the
heart's contractions, as well as the total peripheral resistance. The most
important arterial baroreceptors are located in the left and right carotid
sinuses and in the aortic arch.[31]

Renin-angiotensin system (RAS): This system is generally known for its longterm adjustment of arterial pressure. This system allows the kidney to
compensate for loss in blood volume or drops in arterial pressure by
activating an endogenous vasoconstrictor known as angiotensin II.

Aldosterone release: This steroid hormone is released from the adrenal cortex
in response to angiotensin II or high serum potassium levels. Aldosterone
stimulates sodium retention and potassium excretion by the kidneys. Since
sodium is the main ion that determines the amount of fluid in the blood
vessels by osmosis, aldosterone will increase fluid retention, and indirectly,
arterial pressure.

Baroreceptors in low pressure receptor zones (mainly in the venae cavae and
the pulmonary veins, and in the atria) result in feedback by regulating the
secretion of antidiuretic hormone (ADH/Vasopressin), renin and aldosterone.
The resultant increase in blood volume results an increased cardiac output by
the FrankStarling law of the heart, in turn increasing arterial blood pressure.

These different mechanisms are not necessarily independent of each other, as

indicated by the link between the RAS and aldosterone release. Currently, the RAS is
targeted pharmacologically by ACE inhibitors and angiotensin II receptor
antagonists. The aldosterone system is directly targeted by spironolactone, an
aldosterone antagonist. The fluid retention may be targeted by diuretics; the
antihypertensive effect of diuretics is due to its effect on blood volume. Generally,
the baroreceptor reflex is not targeted in hypertension because if blocked,
individuals may suffer from orthostatic hypotension and fainting.
CLINICAL PRESENTATION OF HYPERTENSION
Hypertension is often an incidental finding when subjects present for screening or
with unrelated conditions. Severe cases may present with headache, usual
disturbances or evidence of target organ damage (stroke, ischemic heart disease or
renal failure).
Malignant Hypertension
Malignant hypertension is extremely high blood pressure that develops suddenly
and rapidly and causes some type of organ damage. "Normal" blood pressure is
below 120/80. A person with malignant hypertension has a blood pressure that's
typically above 180/120. It's considered a hypertensive emergency and should be
treated as a medical emergency.
Causes Malignant Hypertension

In many people, high blood pressure is the main cause of malignant hypertension.
Missing doses of blood pressure medications can also cause it. In addition, there are
certain medical conditions that can cause it. They include:

Collagen vascular disease, such as scleroderma

Kidney disease
Spinal cord injuries
Tumor of the adrenal gland
Use of certain medications, including birth control pills and MAOIs
Use of illegal drugs, such as cocaine

You are at high risk for malignant hypertension if you have had:

Kidney failure

Renal hypertension caused by renal artery stenosis

Symptoms of Malignant Hypertension

The main symptoms of malignant hypertension are a rapidly increasing blood
pressure of 180/120 or higher and signs of organ damage. Usually the damage
happens to the kidneys or the eyes.
Other symptoms depend on how the rise in blood pressure affects your organs. A
common symptom is bleeding and swelling in the tiny blood vessels in the retina.
The retina is the layer of nerves that line the back of the eye. It senses light and
sends signals to the brain through the optic nerve, which can also be affected by
malignant hypertension. When the eye is involved, malignant hypertension can
cause changes in vision.
Other symptoms of malignant hypertension include:

Blurred vision
Chest pain (angina)
Difficulty breathing
Dizziness
Numbness in the arms, legs, and face
Severe headache
Shortness of breath

In rare cases, malignant hypertension can cause brain swelling, which leads to a
dangerous condition called hypertensive encephalopathy. Symptoms include:

Blindness
Changes in mental status

Coma
Confusion
Drowsiness
Headache that continues to get worse
Nausea and vomiting
Seizures

High blood pressure, in general, makes it difficult for kidneys to filter wastes and
toxins from the blood. It is a leading cause of kidney failure. Malignant hypertension
can cause your kidneys to suddenly stop working properly. If this happens, the
condition is called malignant nephrosclerosis.
EXAMS AND TESTS
Malignant hypertension is a medical emergency.
A physical exam commonly shows:

Extremely high blood pressure

Swelling in the lower legs and feet

Abnormal heart sounds and fluid in the lungs

Changes in thinking, sensation, muscle ability, and reflexes

An eye examination will reveal changes that indicate high blood pressure, including:

Bleeding of the retina

Narrowing of the blood vessels in the eye area

Swelling of the optic nerve

Other problems with the retina

Kidney failure, as well as other complications, may develop.

TESTS TO DETERMINE DAMAGE TO THE KIDNEYS MAY INCLUDE:

Arterial blood gas analysis

BUN

Creatinine

Urinalysis

A chest x-ray may show congestion in the lung and an enlarged heart.
This disease may also affect the results of the following tests:

Aldosterone level

Cardiac enzymes (markers of heart damage)

CT scan of the brain

Electrocardiogram (EKG)

Renin level

Urinary sediment

DIAGNOSIS OF HYPERTENSION
You can get your blood pressure measured by a health care provider, at a
pharmacy, or you can purchase a blood pressure monitor for your home.
Blood pressure is most often measured with a device known as a
sphygmomanometer, which consists of a stethoscope, arm cuff, dial, pump, and
valve.
Blood pressure is measured in two ways: systolic and diastolic.

Systolic blood pressure is the maximum pressure during a heartbeat.

Diastolic blood pressure is the lowest pressure between heartbeats.

Blood pressure is measured in millimeters of mercury (mm Hg) and is written

systolic over diastolic (for example, 120/80 mm Hg, or "120 over 80"). According to
the most recent guidelines, a normal blood pressure is less than 120/80 mm Hg.
Hypertension is blood pressure that is greater than 140/90, while prehypertension
consists of blood pressure that is 120 to 139/80 to 89.
Blood pressure may increase or decrease, depending on your age, heart condition,
emotions, activity, and the medications you take. One high reading does not mean
you have high blood pressure. It is necessary to measure your blood pressure at
different times, while you are resting comfortably for at least five minutes. To make
the diagnosis of hypertension, at least three readings that are elevated are usually
required.
In addition to measuring your blood pressure, your doctor will ask about your
medical history (whether you've had heart problems before), assess your risk
factors (whether you smoke, have high cholesterol, diabetes, etc.), and talk about

your family history (whether any members of your family have had high blood
pressure or heart disease).
HOME OR AMBULATORY BLOOD PRESSURE MEASUREMENTS
Ambulatory blood pressure measurement (ABPM) measures blood pressure at regular
intervals. It is believed to be able to reduce the white coat hypertension effect in which a
patient's blood pressure is elevated during the examination process due to nervousness and
anxiety caused by being in a clinical setting. Out-of-office measurements are highly
recommended as an adjunct to office measurements by almost all hypertension
organizations.
The ambulatory blood pressure monitor consists of a cuff which wraps round your arm. The
cuff is attached to a small electric recording device on a belt or strap worn on your body. The
doctor or nurse who supply the device should make sure the cuff is the right size for your
arm. You should keep the device safe and dry and not have a bath or shower whilst wearing
it. From time to time you will feel a tightening sensation in your arm whilst the cuff is
inflating but this will not last very long and most people will not be worried by it. Try not to
move your arm whilst the cuff is inflating. If the device cannot record your blood pressure it
will try to repeat the process up to three times. The machine is usually set to record twice an
hour
whilst
you
are
awake
and
hourly
at
night.
The ambulatory monitor can be worn whilst going about your everyday activities. So, it will
give an accurate impression about how your blood pressure behaves under normal
circumstances. The doctor will look at at least 14 readings spread throughout the day to
decide whether or not you have hypertension.
Home blood pressure
This is an alternative to ambulatory blood pressure measurement. The process for doing this
will be exactly the same as that used by the doctor or nurse in the surgery. You will be given
a blood pressure monitor to use at home. Wrap the cuff around your arm just above the level
of the elbow. (Check the instructions with the monitor to make sure the tubing is in the right
position.) You should be seated comfortably with your arm supported (for example, on a
table) at the level of your heart. Press the button to inflate the machine and make a note of
the
reading.
You should measure your blood pressure twice a day, once in the morning and once in the
evening. On each occasion you should take two readings, one minute apart. You should take
readings for at least four days, and ideally for seven days. The doctor should use all the
readings, apart from those taken on the first day, to calculate your average blood pressure.

ASSESMENT OF THE HYPERTENSIVE PATIENT

SECONDARY CAUSE

Although in the majority of patients hypertension is primary/essential, there are

certain features that may lead to a suspicion of an underlying cause (secondary
hypertension):

Young patient (<40 years)

Rapid onset of hypertension

Sudden change in blood pressure readings when previously well controlled on

a particular therapy

Resistant hypertension that is unresponsive to pharmacological therapies.

If a secondary cause is suspected, then the presence of specific symptoms may

suggest a particular cause and guide further investigations:

Flash pulmonary oedema or widespread atherosclerosis may indicate renal

artery stenosis

Poor feeding in children, or cold legs, may indicate poor distal perfusion
secondary to aortic coarctation

Swelling and hypertension in a pregnant patient should raise suspicion of preeclampsia

Oedema and reports of foamy urine in a non-pregnant patient may represent

nephrotic syndrome

A history of renal impairment, prostatic enlargement, previous urethral

instrumentation, or renal calculi is consistent with obstructive uropathy or
chronic kidney disease

A family history of polycystic kidney disease, intracranial aneurysms, or

subarachnoid haemorrhage in a young patient with hypertension is strongly
suggestive of polycystic kidney disease

Endocrine causes may present with numerous non-specific symptoms, but

phaeochromocytoma usually has episodic symptoms consistent with a hyperadrenergic state, such as panic attacks, sweating, palpitations, and
abdominal cramps

Symptoms of low potassium, such as headaches, nocturia, and

paraesthesiae, may indicate hyperaldosteronism, although the majority of
patients with this condition are normokalaemic

Typical symptoms of Cushing's syndrome are depression, weight gain,

hirsutism, easy bruising, and low libido

Heat intolerance, sweating, palpitations, and weight loss may indicate an

excess of thyroxine, while lethargy, constipation, weight gain, and depression
are common findings with low circulating thyroxine levels

Symptoms of bone pain, paraesthesiae, and myalgia may suggest

hyperparathyroidism

Excessive daytime sleepiness in an obese patient, who may also complain of

erectile dysfunction and restless sleep, may be a symptom of obstructive
sleep apnoea. Partners are likely to give a history of loud snoring

Symptoms of a toxic cause include consumption of the oral contraceptive pill

or NSAIDs, or chronic alcohol excess. There may be accompanying social,
economic, or legal issues due to alcohol excess.

Physical findings suggestive of a secondary cause include the following:

Renal bruits may be audible with renal artery stenosis

Enlarged kidneys may be palpated in polycystic kidney disease. There may

be accompanying hepatomegaly or a hernia

Arteriovenous fistulae may be present in a patient with end-stage kidney

disease

Flank tenderness or prostatic enlargement on rectal examination may

suggest a cause of obstructive uropathy

Facial oedema or limb oedema in a pregnant patient warrants urinary

collection for proteinuria as suggestive of pre-eclampsia.

Oedema in a non-pregnant patient might be due to nephrotic syndrome.

Radio-femoral delay and a disparity in blood pressure readings between the

arms may be demonstrated with coarctation of the aorta, along with systolic
or continuous cardiac murmurs. Distal pulses may be weak or impalpable

Cushing's syndrome has well defined features, typically described as a moon

face, thin arms and legs, truncal obesity, striae, and skin thinning

Isolated eyelid oedema with dry skin and a thick tongue may suggest
hypothyroidism, while exophthalmos, proptosis, and lid lag suggest
hyperthyroidism due to Graves' disease

The deposition of calcium just inside the iris, or palpation of jaw tumours,
raises the possibility of hyperparathyroidism

Obesity, maxillomandibular abnormalities, and macroglossia predispose to

obstructive sleep apnoea, and there may be sweating in paediatric patients

Chronic alcohol excess can result in a myriad of signs, such as jaundice,

hepatomegaly, spider nevi, ascites, and general neglect of appearance

CONTRIBUTING FACTORS
High blood pressure has many risk factors, including:

Age. The risk of high blood pressure increases as you age. Through early
middle age, high blood pressure is more common in men. Women are more
likely to develop high blood pressure after menopause.

Race. High blood pressure is particularly common among blacks, often

developing at an earlier age than it does in whites. Serious complications,
such as stroke and heart attack, also are more common in blacks.

Family history. High blood pressure tends to run in families.

Being overweight or obese. The more you weigh, the more blood you
need to supply oxygen and nutrients to your tissues. As the volume of blood
circulated through your blood vessels increases, so does the pressure on your
artery walls.

Not being physically active. People who are inactive tend to have higher
heart rates. The higher your heart rate, the harder your heart must work with
each contraction and the stronger the force on your arteries. Lack of
physical activity also increases the risk of being overweight.

Using tobacco. Not only does smoking or chewing tobacco immediately

raise your blood pressure temporarily, but the chemicals in tobacco can
damage the lining of your artery walls. This can cause your arteries to
narrow, increasing your blood pressure. Secondhand smoke also can increase
your blood pressure.

Too much salt (sodium) in your diet. Too much sodium in your diet can
cause your body to retain fluid, which increases blood pressure.

Too little potassium in your diet. Potassium helps balance the amount of
sodium in your cells. If you don't get enough potassium in your diet or retain
enough potassium, you may accumulate too much sodium in your blood.

Too little vitamin D in your diet. It's uncertain if having too little vitamin D
in your diet can lead to high blood pressure. Vitamin D may affect an enzyme
produced by your kidneys that affects your blood pressure.

Drinking too much alcohol. Over time, heavy drinking can damage your
heart. Having more than two drinks a day can raise your blood pressure.

Stress. High levels of stress can lead to a temporary, but dramatic, increase
in blood pressure. If you try to relax by eating more, using tobacco or drinking
alcohol, you may only increase problems with high blood pressure.

Certain chronic conditions. Certain chronic conditions also may increase

your risk of high blood pressure, including high cholesterol, diabetes, kidney
disease and sleep apnea.

Though the exact causes of hypertension are usually unknown, there are several
factors that have been highly associated with the condition. These include:

Smoking

Obesity or being overweight

Diabetes

Sedentary lifestyle

Lack of physical activity

High levels of salt intake (sodium sensitivity). According to the American

Heart Association (AHA), sodium consumption should be limited to 1,500
milligrams per day, and that includes everybody, even healthy people
without high blood pressure, diabetes or cardiovascular diseases. AHA's chief
executive officer, Nancy Brown said "Our recommendation is simple in the
sense that it applies to the entire U.S population, not just at-risk groups.
Americans of all ages, regardless of individual risk factors, can improve the
heart health and reduce their risk of cardiovascular disease by restricting
their daily consumption of sodium to less that 1,500 milligrams." The
recommendation was published in the journal Circulation (November 5th,
2012 issue)

Insufficient calcium, potassium, and magnesium consumption

Vitamin D deficiency

High levels of alcohol consumption

Stress

Aging

Medicines such as birth control pills

Genetics and a family history of hypertension - In May 2011, scientists from

the University of Leicester, England, reported in the journal Hypertension that
some genes in the kidneys may contribute to hypertension.

Chronic kidney disease

Adrenal and thyroid problems or tumors

Sometimes pregnancy contributes to high blood pressure, as well.

Although high blood pressure is most common in adults, children may be at risk,
too. For some children, high blood pressure is caused by problems with the kidneys
or heart. But for a growing number of kids, poor lifestyle habits such as an
unhealthy diet and lack of exercise contribute to high blood pressure. It is
important to establish whether there is a family history of cardiovascular disease.

END ORGAN DAMAGE IN HYPERTENSION

Damage of organs fed by the circulatory system due to uncontrolled hypertension is
called end-organ damage. As already mentioned, chronic high blood pressure can
lead to an

Enlarged heart,

Kidney failure,

Brain or neurological damage, and

Changes in the retina at the back of the eyes.

Examination of the eyes in patients with severe hypertension may reveal damage;

Narrowing of the small arteries,

Small hemorrhages (leaking of blood) in the retina, and

Swelling of the eye nerve

From the amount of damage, the doctor can gauge the severity of the hypertension.
People with high blood pressure have an increased stiffness, or resistance, in the
peripheral arteries throughout the tissues of the body. This increased resistance
causes the heart muscle to work harder to pump the blood through these blood
vessels. The increased workload can put a strain on the heart, which can lead to
heart abnormalities that are usually first seen as enlarged heart muscle.
Enlargement of the heart can be evaluated by

Chest x-ray,

Electrocardiogram, and

Most accurately by echocardiography (an ultrasound examination of the

heart)

Echocardiography is especially useful in determining the thickness (enlargement) of

the left side (the main pumping side) of the heart. Heart enlargement may be a
forerunner of

Heart failure,

Coronary (heart) artery disease, and

Abnormal heart rate or rhythms (cardiac arrhythmias)

Proper treatment of the high blood pressure and its complications can reverse some
of these heart abnormalities.
Blood and urine tests may be helpful in detecting kidney abnormalities in people
with high blood pressure. (Remember that kidney damage can be the cause or the
result of hypertension.)
Measuring the serum creatinine in a blood test can assess how well the kidneys
are functioning. An elevated level of serum creatinine indicates damage to the
kidney. In addition, the presence of protein in the urine (proteinuria) may reflect
chronic kidney damage from hypertension, even if the kidney function (as
represented by the blood creatinine level) is normal. Protein in the urine alone
signals the risk of deterioration in kidney function if the blood pressure is not

controlled. Even small amounts of protein (microalbuminuria) may be a signal of

impending kidney failure and other vascular complications from uncontrolled
hypertension.
Uncontrolled hypertension can cause strokes, which can lead to brain or
neurological damage. The strokes are usually due to a hemorrhage (leaking blood)
or a blood clot (thrombosis) of the blood vessels that supply blood to the brain. The
patient's symptoms and signs (findings on physical examination) are evaluated to
assess the neurological damage. A stroke can cause weakness, tingling, or paralysis
of the arms or legs and difficulties with speech or vision. Multiple small strokes can
lead to dementia (impaired intellectual capacity). The best prevention for this
complication of hypertension or, for that matter, for any of the complications, is
control of the blood pressure. Recent studies have also suggested the angiotensin
receptor blocking drugs may offer an additional protective effect against strokes
above and beyond control of blood pressure.

DETERMINATION OF CARDIOVASCULAR RISK

An accurate assessment of cardiovascular disease risk is essential before
recommending appropriate management in hypertension. Patients with documented
atheromatous vascular disease, for example: previous myocardial infarction or
stroke, angina or peripheral vascular diseases are at high risk of recurrent events.
Those with type 2 diabetes over 40 years of age are also at high risk and can be
regarded as coronary equivalents, i.e. with the risk similar to non-diabetic patients
with previous myocardial infarction.
Other factors to consider include micro-albuminuria which increase cardiovascular
risk by a factor of 2-3 and the combination of reduced GFR and micro-albuminuria
may increase risk by as much as 6 folds.
TREATMENT
Non-pharmacological approaches
Reduction in body fat is one of the most effective and long lasting treatments for
hypertension. Weight control reduces the risk of hypertension, and even a modest reduction
in body weight may significantly lower blood pressure. Not only does physical activity help
with weight control, but also moderate exercise, specifically aerobics, helps lower blood
pressure directly. Back in 1990, a study in the Journal of the American Medical Association
stated that those who engage in regular aerobic activity might not need medication for mild
hypertension (263; 2766-2771).
Diet can be a powerful strategy to combat hypertension. An ideal diet would be one that is
designed specifically for a patient. However, in general an anti hypertension diet should
include all essential nutrients, be rich in fiber, high in potassium, calcium, and magnesium
from vegetables, fruits, legumes, whole grains, low fat dairy or dairy substitutes fortified to
match the nutritional profile of dairy, low in sodium and saturated fat, with total fat from

monounsaturated and polyunsaturated sources totaling 30% of calories, and conducive to

weight loss. Such a diet supports, the 1997 recommendations of the Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. This
diet, which was rigorously evaluated in the Dietary Approaches to Stop Hypertension (DASH)
clinical trial, substantially lowered blood pressure in normotensive and hypertensive
individuals.(6) As noted in this diet, sodium is reduced. The association of a high sodium diet
and high blood pressure has been established. However, there may be an even stronger
incentive to reduce dietary sodium levels. In the December 1, 1999 issue of the Journal of
the American Medical Association, researchers studied the relationship between dietary
sodium and cardiovascular disease risk in overweight and nonoverweight individuals. They
concluded that high sodium intake is strongly and independently associated with an
increased risk of cardiovascular disease and all cause mortality in overweight individuals
(282: 2027-2034). However, remember that we are all biochemically unique, and one
person's food may actually be another person's poison. It is important to consult a certified
nutritionist to design an individualized diet.

DRUG TREATMENT
There is a wide range of blood-pressure-lowering medicines to choose from. You
may need to take more than one type of medication because a combination of
drugs is sometimes needed to treat high blood pressure.
In some cases, you may need to take blood pressure-lowering medication for the
rest of your life. However, if your blood pressure levels stay under control for
several years, you might be able to stop your treatment.
Most medications used to treat high blood pressure can produce side effects but the
large choice of blood pressure medicines means that these can often be resolved by
changing treatments.
Let your GP know if you have any of the following common side effects while taking
medication for high blood pressure:

feeling drowsy

pain around your kidney area (on the side of your lower back)

a dry cough

dizziness, faintness or light-headedness

a skin rash

Below are the most widely used medications for treating high blood pressure.
Different high blood pressure treatments work better for different ethnic groups.
Your GP will consider your ethnic background when making a treatment plan.

ACE inhibitors
Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing
your blood vessels. The most common side effect is a persistent dry cough. If side
effects become particularly troublesome, a medication that works in a similar way
to ACE inhibitors, known as an angiotensin-2 receptor antagonist, may be
recommended.
ACE inhibitors can cause unpredictable effects if taken with other medications,
including some over-the-counter ones. Check with your GP or pharmacist before
taking anything in combination with this medication.
Calcium channel blockers
Calcium channel blockers keep calcium from entering the muscle cells of the heart
and blood vessels. This widens your arteries (large blood vessels) and reduces your
blood pressure.
Drinking grapefruit juice while taking some types of calcium blockers can increase
your risk of side effects. You can discuss the possible risks with your GP or
pharmacist.
Diuretics
Sometimes known as water pills, diuretics work by flushing excess water and salt
from the body through urine.
Beta-blockers
Beta-blockers work by making your heart beat more slowly and with less force,
thereby reducing blood pressure.
Beta-blockers used to be a popular treatment for high blood pressure but now they
only tend to be used when other treatments have not worked. This is because betablockers are considered to be less effective than the other medications used to treat
high blood pressure.
Beta-blockers can also interact with other medications, causing possible side
effects. Check with your GP or pharmacist before taking other medications in
combination with beta-blockers.
Don't suddenly stop taking beta-blockers without first consulting your GP. Stopping
suddenly will lead to serious side effects, such as a rise in blood pressure or an
angina attack.

Alpha-blockers
Alpha-blockers are not usually recommended as a first choice for lowering high
blood pressure unless other treatments have not worked. Alpha-blockers work by
relaxing your blood vessels, making it much easier for blood to flow through them.
Common side effects of alpha-blockers include:

fainting spells when you first start the treatment

dizziness

headache

swollen ankles

tiredness