Blood Pressure Tablets

[coccinelle]

How do BP tablets lower blood pressure? There are loads of BP tablets on the market so how can your GP decide which is best for you or is it trial and error....? I imagine it depends on whether which of the Sys or the Dia numbers are high or both, but I would really like to know how these tablets work.

[bednobs]

different tablets work differently. For example ace inhibitors, beta blockers, water tablets and so on

[coccinelle]

Thanks bednobs for your answer, but how does your GP know what puts your BP up to know how to treat it? I have a sister who takes a water tablet every day and has that problem of having to 'not do' things on a morning as she needs the toilet. How did her GP decide that was the tablet for her? By the way, her BP is still high.

[TWR]

coccinelle her GP has her records, please do NOT BE TEMPTED to bye off the net, there are some very dangerous drugs out there.

[coccinelle]

TWR; I would not buy off the net. I'm just asking as to how a GP decides which drug to prescribe. I hear some people on here say they tell their GP there is such and such a problem so they move them to another tablet. Can't they prescribe the answer to the high blood pressure problem directly?

[Old_Geezer]

No expert but surely the cause is going to be restricted blood vessels ? And the solution to encourage them to dilate ?

[Sqad]

It is very difficult to know at what level to pitch this answer so please forgive me if the simplicity insults you intelligence.
Old –Geezer is correct, your BP depends on the diameter of your blood vessels, the narrower the vessels the higher the BP, the wider the blood vessels the lower the BP, so you see that all methods of treatments concentrate on widening the blood vessels.
The state of the blood vessels depends on certain nerve and chemical(enzyme) control and it is on these that drugs do their work.
Hexamethonium, hydralazine and reserpine (derived from the medicinal plant Rauwolfia serpentina) was the first drug to be used after in the early 60’s followed by Saluric (hydrochlorthiazide) which were basically diuretics and had side effects such as potassium loss.
Then a revolution in the late 60’s.....beta –blockers...they also had undesired side effects.
Next came calcium channel blockers....cheap and few side effects...e,g Verapomil...very popular.
Then a pharmacological breakthrough.....an attack on the enzymes themselves. (ACE inhibitors )
How does the doctor know which one to start the patient on? Depends in which country you live.
Basically it depends on the degree of high BP and from then on trial and error...a drug that does the job, free of side effects and reasonably cheap.......and luckily there are plenty of choices.

[Robinia]

The nurse at my practise told me they start with a diuretic. If that makes no difference they add an ACE inhibitor (lots of different ones) and lastly they prescribe betablockers. I'm on all three. :( ....but the beta blocker is a low dose and a preventative for migraines.

[Sqad]

Robinia.....I stand to be corrected, but in the UK the GP's were advised to start treatment following "Nice Recommendations" but talking to my mates, very few now would start treatment with just a diuretic.

On the continent you would almost certainly be started on beta blockers or ACE inhibitors, or both...depending upon the degree of hypertension.

[seadogg]

I take it that once you are on them its permanent?

[Sqad]

seadogg........yepp!

[seadogg]

ta! Sqad. yep 5mg Amlodipene calcium channel blocker for me at 77

[Sqad]

That sounds good medical care seadogg.

[slaney]

The most recent NICE guidelines suggest going through the following steps for treatment of those over 55s with primary hypertension, until good control is reached.
Step 1. Calcium-channel blocker.
Step 2. ACE inhibitor or angiotensin II receptor blocker + calcium-channel blocker.
Step 3. ACE inhibitor or angiotensin II receptor blocker + calcium-channel blocker + thiazide-like diuretic
etc.
http://pathways.nice.org.uk/pathways/hypertension#path=view%3A/pathways/hypertension/antihypertensive-drug-treatment.xml&content=close
The sequence may differ in other countries.

[McMouse]

I've been treated for high BP for years and have basically been on the regime outlined by sqad. My BP, cholesterol, oedema etc. etc are now stable due to a cocktail of drugs that has evolved. My only problem is when a routine visit to the cardiac clinic prompts a letter to my GP suggesting a change in medication which then upsets the entire thing. This happened two weeks ago when I was put on an additional blood thinner which has brought on unwelcome side effects.

[Sqad]

McMouse.......did you see the consultant or the registrar?

Bloody annoying....why DO doctors do this? Blood investigations you said were normal....if it aint broke, don't mend it.

[whiskeryron]

If this is of any help to ABers. Amongst other drugs to help lower my BP I am taking 1 tablet of Furosemide 40mg daily. I discovered that it takes roughly 3 hours to clear my system so I have my alarm set to 06.30 every morning to take tablet then another kip for 1 hour then out of bed for a tinkle then once showered & dressed peeing until about 09.30, then clear to go about my business uninterrupted for the rest of the day, the problem being for most people that they leave the medication until later in the morning & then of course it spoils their day.

WR

[coccinelle]

Thank you for your answers. I now realise BP tablets make sure the blood vessels rest open rather than treating the cause of the high blood pressure. I now understand that stress narrows the vessels which causes BP to go up whereas it's normal when not under stress. This also explains how sport helps to lower BP.