High Blood Pressure and Health Problems
Suffering from high blood pressure for long time may cause cardiovascular and other health problems, such as heart disease, stroke, loss of eyesight, chronic kidney disease, and other blood vessel diseases. Therefore, it is very important to treat the high blood pressure and keep it under control for healthy life.
At the beginning, doctors recommend the patients to follow healthy lifestyle choices to control high blood pressure if it works, and they monitor the blood pressure level. The patients have elevated blood pressure if their blood pressure reading is 120/80 to 129/80 mm Hg. Doctors may recommend the patients to change their lifestyle choices to lower blood pressure level down to the normal range. At this beginning stage, doctors rarely prescribe medicines. However, doctors may recommend medicines to control high blood pressure if lifestyle changes can’t lower the high blood pressure to the safe level.
Treatments for high blood pressure:
High blood pressure reading can be grouped in two stages.
Stage 1:
Blood pressure is equal to or higher than 130/80, but lower than 140/90 mm Hg. Doctors may recommend medicines to treat high blood pressure. But if the patients have other diseases or risk factors, their doctors may recommend them both medicines and lifestyle changes at the same time.
Stage 2
Blood pressure is equal to or higher than 140/90 mm Hg. The doctors will most likely recommend that the patients take medicines and adopt lifestyle changes.
High risk patients
Doctor will recommend the patient to measure and monitor their blood pressure regularly before making a final diagnosis of either elevated blood pressure or high blood pressure. If some patients have a higher risk for heart disease, diabetes, heart problems, or a history of a stroke, doctors may prescribe medicines even at lower blood pressure reading below 130/80.
Medicines for high blood pressures
Generally, doctors recommend the patients to take only a single drug at first, but they can recommend two drugs if the patients have stage 2 high blood pressure. There are several types of medicines for treatment of high blood pressure. Doctors will decide which medicine is right for the patient. Sometimes, doctors may recommend the patient to take more than one type of medicine. Different pharmaceutical companies manufacture these medicines under their own brand names. Different types of medicines are listed and described below. Each type of blood pressure medicine is manufactured and marketized under different brand and generic names.
ACE inhibitors
Angiotensin-converting enzyme inhibitors are called ACE inhibitors. They are a type of medicines that prevent enzymes to produce angiotensin II in your body. Angiotensin II narrows blood vessels, which can cause high blood pressure and forces the heart to work harder. Furthermore, Angiotensin II also releases hormones increasing blood pressure. Therefore, ACE inhibitors help relax your blood vessels, which lowers your blood pressure.
Common examples are enalapril, lisinopril, perindopril and ramipril.
ACE inhibitors may show the most common side effect of a persistent dry cough. They may demonstrate other possible side effects of headaches, dizziness and a rash.
Angiotensin II receptor blockers (ARBs)
Angiotensin II receptor blockers are called ARBs. Angiotensin II receptor blockers reduce the action of angiotensin II in your body, which helps relax your blood vessels and lowers your blood pressure. Therefore, ARBs work in a similar way to ACE inhibitors. The doctors often recommended ARBs if ACE inhibitors cause troublesome side effects.
Common examples are candesartan, irbesartan, Iosartan, valsartan and olmesartan.
Uptake of these medications can show the possible side effects of dizziness, headaches, and cold or flu-like symptoms.
Calcium channel blockers
Calcium channel blockers reduce blood pressure by widening your blood vessels. Calcium channel blockers relax blood vessels by reducing calcium entering cells in the wall of the blood vessels.
Common examples are amlodipine, felodipine and nifedipine. Other medicines, such as diltiazem and verapamil, are also available.
Possible side effects include headaches, swollen ankles and constipation. Drinking grapefruit juice along with taking some calcium channel blockers can increase your risk of side effects.
Diuretics
They are, sometimes, called water pills. Diuretics remove excess water and salt from the body through your pee. They help your kidneys remove some salt (sodium) from your body. As a result, your blood vessels don’t have to hold as much fluid and your blood pressure goes down.
They’re often used instead of calcium channel blockers if calcium channel blockers cause troublesome side effects, or if you have signs of heart failure.
Common examples are indapamide and bendroflumethiazide.
Possible side effects include dizziness when standing up, increased thirst, needing to go to the toilet frequently, and a rash. You might also get low potassium and low sodium after long-term use. You’ll have regular blood tests to check for this.
Beta blockers
Beta-blockers can reduce blood pressure by making the heart beat at a slower rate and with less force. They used to be a popular treatment for high blood pressure, but now tend to be used only when other treatments have not worked. Beta blockers are considered less effective than other blood pressure medicines.
Common examples are atenolol and bisoprolol.
Possible side effects include dizziness, headaches, tiredness, and cold hands and feet.
Following blood pressure medicines are not used as often:
Alpha-blockers help relax your blood vessels, which lowers your blood pressure.
Centrally acting drugs signal your brain and nervous system to relax your blood vessels.
Vasodilators signal the muscles in the walls of blood vessels to relax.
Renin inhibitors act by reducing the amount of angiotensin precursors thereby relaxing your blood vessels.
References
Source: MedlinePlus, 2023. High blood pressure medications. URL: https://medlineplus.gov/ency/article/007484.htm
Source: NHS, 2023. Treatment-High blood pressure (hypertension). URL: https://www.nhs.uk/conditions/high-blood-pressure-hypertension/treatment/. Accessed on 06/05/2023.
Dual benefits of cardiovascular therapeutics for cardiovascular disease and anxiety treatment
Dr Md Anawar Hossain
The cardiovascular disorders, hypertension, coronary artery disease, and mental disturbances, such as anxiety and depressive disorders are the most common problems among the people, which are causing the high rate of morbidity and death. Anxiety and depression deteriorate the cardiovascular disease and pathologies. On the other hand, the cardiovascular diseases may cause the mental and emotional disturbances. There is bidirectional relationship between the psychological disturbances and cardiovascular diseases. Therefore, the patients with cardiovascular diseases should be examined and treated for their disturbances of emotions, cognition, and behavior (Repova et al., 2022).
When patients with heart or vasculature disturbances take principal cardiovascular drugs, the medicines can interact with the mental state of the patient and optimize their therapeutic benefit. The beta-blockers, central sympatholytics, ACE inhibitors, ARBs, aldosterone receptor blockers, sacubitril/valsartan, and fibrates are presumed to have anxiolytic effect in animal experiments and clinical settings. Therefore, when the patients with cardiovascular diseases are treated, their mental condition, cognition and behavior should be taken into account to select the cardiovascular drugs, which can provide them with benefit for both mental disturbances and cardiovascular disorders.
Relationship between mental disturbances and cardiovascular diseases
Depressive disorders are one of the reasons of disability. The cardiovascular diseases have close relationship with mental disorders, such as anxiety and depression (Repova et al., 2022).
The psychosocial disorders such as anxiety, hostility, stress, or conflict situations stimulate and activate autonomic nervous system and neurohumoral cascade resulting in development of endothelial dysfunction, hypertension, diabetes mellitus, and target organ damage. On the other hand, the cardiovascular pathologies associated with neurohumoral imbalance result in the formation of anxiety and mental disorders. The patients with anxiety have high risk of cardiovascular diseases, such as coronary artery disease, stroke, heart failure, and cardiovascular death, whilst cardiovascular diseases coincide with anxiety development. The above phenomena indicate the bidirectional relationship between (1) the negative emotions and mental disturbances in the form of distress, anxiety, or depression and (2) increased risk of cardiovascular diseases. Cardiac patients and patients with anxiety demonstrate the similar symptoms, such as nervousness, palpitations, apprehension, fatigue, breathlessness, headache, sweating, dizziness, or insomnia. A diagnosis of anxiety can even indicate the future adverse cardiovascular disease (Repova et al., 2022).
Impact of cardiovascular drugs on mental disorders
Cardiovascular drugs which are used to treat the patients with cardiovascular diseases may also affect the development and severity of anxiety or depression. A considerable number of experimental and clinical studies have been conducted to determine the impact of different cardiovascular drug groups on anxiety or depression. Repova et al. (2022) made a review to focus on the impact of currently used, well-established cardiovascular treatment for mental disturbances including anxiety and depression, which will indicate the future clinical and research directions.
Beta-blockers and drugs interfering with the renin-angiotensin-aldosterone system are considered to be important. Selective beta-blockers might be more effective in alleviating mental stress and anxiety disorders. Actually, selective beta-blockers decreased symptoms of anxiety in patients with chronic heart failure (metoprolol), mitral valve prolapse syndrome (celiprolol) and anxiety-related mental health problems (atenolol). There are different types of cardiovascular drugs. Out of them, beta-blockers, ACE inhibitors, ARBs, aldosterone receptor blockers, and sacubitril/valsartan are presumed to have an anxiolytic effect in animal experiments and clinical settings.
The mutual interactions between cardiovascular diseases and mental disorders including anxiety can improve health-related quality of life. Anxiety coming from cardiovascular pathology or developed independently from heart disorder can deteriorate cardiovascular prognosis. The impact of cardiovascular drugs on the mental state of the patient will open a new door of optimal treatment providing mutual benefit for the cardiovascular patients. The cardiovascular patients should be monitored whether they are showing any changes in their mood, cognition, and behavior in terms of distress and anxiety, because this will help to prevent worsening of their conditions. Finally, we should explore further to enhance our understanding about therapeutics regarding their possible interference with mood, mind, and behavior, which could help manage both the cardiovascular diseases and mental disturbances of the population with cardiovascular pathologies.
Reference
Repova K., Aziriova S., Krajcirovicova K., Simko F., 2022. Cardiovascular therapeutics: A new potential for anxiety treatment? Med Res Rev. 42(3):1202-1245.