Blood pressure medications: Not everyone can use the same medication

The threshold of 140/90 is generally accepted as the threshold for starting medication. However, if the patient has kidney disease, diabetes, or cardiovascular disease, the target value is lower: 130/80. Sometimes, treatment can be initiated even when the blood pressure is 135/85. The goal is not simply to lower the blood pressure but to prevent organ damage. (Source: European Society of Hypertension – Treatment Thresholds in 2023 Guidelines)

Why are the side effects different?

The effects of the same medication can be very different in two patients because:

- Genetic structure. - Age. - Liver and kidney metabolism.

- Other diseases.

It changes how the body processes the medication. So, a medication that works great for one person may cause serious problems for someone else. (Source: Harvard Health – Variability in Medication Response)

Do medications affect sexuality?

Some blood pressure medications can cause decreased libido or erectile dysfunction. Older beta-blockers, in particular, are notorious for this. Newer-generation medications have reduced this effect. However, if you have any concerns, they should be discussed with your doctor. The solution should be to switch medications, not stop them. (Source: Journal of Sexual Medicine – Antihypertensives and Sexual Side Effects)

By whom are medications chosen?

Every patient's blood pressure profile is different. Some people experience high blood pressure at night, while others also experience a high pulse rate.

Moreover:

- Age - Weight - Concomitant diseases - Use of other medications

Many factors, such as kidney function, determine which medication is given. (Source: American Heart Association – Patient-Centered Therapy in Hypertension)

Is the dose of the drug fixed?

No. Blood pressure medications are generally started with a low dose. If the effect is insufficient, the dose is increased or another group is added. Many patients use combination therapy: for example, a beta-blocker plus a diuretic. However, using more medication does not necessarily mean more effective. Every medication has its own risks. (Source: Cleveland Clinic - Titration Strategy in Hypertension Therapy)

Are blood pressure lowering medications used for life?

Yes, in most patients. Because hypertension is a chronic disease, some people can reduce their medication dose through lifestyle changes. In some mild cases, it's even possible to stop taking the medication altogether.

Of course, this decision must be made under the supervision of a physician. Randomly stopping medication can lead to a crisis. (Source: ESC Position Paper – Withdrawal of Antihypertensive Therapy)

Conclusion: It is not the name of the drug but the patient's condition that is important.

There's no standard prescription for blood pressure treatment. Not everyone can use the same medication. The right medication, the right patient, and the right timing must be considered together. Open communication with the doctor, reporting side effects, and patient follow-up are key to success.

"I take medication but my blood pressure doesn't drop."

There may be three main reasons why blood pressure doesn't drop: 1. Non-compliance: The patient isn't taking the medication regularly. 2. Secondary hypertension: There's another underlying disease (e.g., renal vascular occlusion).

3. Resistant hypertension: Even if 3 drugs are used, control cannot be achieved.

In such cases, the disease assessment, not the drug dose, should be reviewed. (Source: NIH – Resistant Hypertension Clinical Review)

The 5 most commonly used blood pressure medications

1. ACE inhibitors (examples: ramipril, enalapril): They relax blood vessels. They are preferred in patients with heart and kidney disease. The most common side effect is a dry cough.

2. Beta blockers (e.g., metoprolol, bisoprolol): Slows the heart rate. They are given to those who have had a heart attack or are experiencing palpitations. They can cause fatigue and decreased libido.

3. Diuretics (e.g., hydrochlorothiazide): Removes excess salt and fluid from the body. Effective in the elderly and those with salt sensitivity. Electrolyte loss and frequent nighttime urination may occur.

4. Calcium channel blockers (e.g., amlodipine): Relaxes vascular smooth muscle. This is the most commonly used group. May cause foot edema and headaches.

5. ARBs (examples: valsartan, losartan): Similar to the ACE group but do not cause cough. They are often preferred in young patients.

(Source: Mayo Clinic – Antihypertensive Drug Classes and Effects)

Tomorrow

- What is a blood pressure crisis? - Which values ​​carry immediate risk? - When should home intervention be performed and when should one go to the emergency room?

- What are the 7 common mistakes made during a crisis?