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HYPERTENSION

What is high blood pressure? What causes high blood pressure?

Blood pressure is the force of blood pushing against blood vessel walls. The heart pumps blood into the arteries (blood vessels), which carry the blood throughout the body. High blood pressure, also called hypertension, is dangerous because it makes the heart work harder to pump blood to the body and it contributes to hardening of the arteries or atherosclerosis and the development of heart failure.

What Is "Normal" Blood Pressure?

There are several categories of blood pressure, including:

· Normal: Less than 120/80

· Prehypertension: 120-139/80-89

· Stage 1 high blood pressure: 140-159/90-99

· Stage 2 high blood pressure: 160 and above/100 and above

People whose blood pressure is above the normal range should consult their doctor about methods for lowering it.

What Causes High Blood Pressure?

The exact causes of high blood pressure are not known. Several factors and conditions may play a role in its development, including:

· Smoking

· Being overweight

· Lack of physical activity

· Too much salt in the diet

· Too much alcohol consumption (no more than 1 to 2 drinks per day)

· Stress

· Older age

· Genetics

· Family history of high blood pressure

· Chronic kidney disease

· Adrenal and thyroid disorders

Essential Hypertension

In as many as 95% of reported high blood pressure cases in the United States, the underlying cause cannot be determined. This type of high blood pressure is called essential hypertension.

Though essential hypertension remains somewhat mysterious, it has been linked to certain risk factors. High blood pressure tends to run in families and is more likely to affect men than women. Age and race also play a role. In the United States, blacks are twice as likely as whites to have high blood pressure, although the gap begins to narrow around age 44. After age 65, black women have the highest incidence of high blood pressure.

Essential hypertension is also greatly influenced by diet and lifestyle. The link between salt and high blood pressure is especially compelling. People living on the northern islands of Japan eat more salt per capita than anyone else in the world and have the highest incidence of essential hypertension. By contrast, people who add no salt to their food show virtually no traces of essential hypertension.

The majority of all people with high blood pressure are "salt sensitive," meaning that anything more than the minimal bodily need for salt is too much for them and increases their blood pressure. Other factors that have been associated with essential hypertension include obesity; diabetes; stress; insufficient intake of potassium, calcium, and magnesium; lack of physical activity; and chronic alcohol consumption.

Secondary Hypertension

When a direct cause for high blood pressure can be identified, the condition is described as secondary hypertension. Among the known causes of secondary hypertension, kidney disease ranks highest. Hypertension can also be triggered by tumors or other abnormalities that cause the adrenal glands (small glands that sit atop the kidneys) to secrete excess amounts of the hormones that elevate blood pressure. Birth control pills -- specifically those containing estrogen -- and pregnancy can boost blood pressure, as can medications that constrict blood vessels.

Who Is More Likely to Develop Hypertension?

· People with family members who have high blood pressure.

· People who smoke.

· African-Americans.

· Women who are pregnant.

· Women who take birth control pills.

· People over the age of 35.

· People who are overweight or obese.

· People who are not active.

· People who drink alcohol excessively.

· People who eat too many fatty foods or foods with too much salt.

Hypertension: Symptoms of High Blood Pressure

One of the most dangerous aspects of hypertension is that you may not know that you have it. There are generally no symptoms of high blood pressure, so you usually don't feel it. In fact, nearly one-third of people who have hypertension don't know it. The only way to find out if you have high blood pressure is to get your blood pressure checked on a regular basis. This is especially important if you have a close relative who has high blood pressure.

If your blood pressure is extremely high, there may be certain symptoms to look out for, including:

· Severe headache

· Fatigue or confusion

· Vision problems

· Chest pain

· Difficulty breathing

· Irregular heartbeat

· Blood in the urine

If you have any of these symptoms, see a doctor immediately. You could be having a hypertensive crisis that could lead to a heart attack or stroke.

Untreated hypertension can lead to serious diseases, including stroke, heart disease, kidney failure and eye problems.

Hypertension: Hypertensive Crisis

Hypertensive crisis comprises a spectrum of conditions, including hypertensive urgency and hypertensive emergency. When blood pressure gets critically high, organ damage may occur.

Hypertensive Urgency

When blood pressure spikes, but there is no damage to the body's organs as a result and blood pressure can be brought down safely within a few hours with blood pressure medication this is referred to as hypertensive urgency.

Hypertensive Emergency

When organ damage occurs as a result of severely elevated high blood pressure, this is considered a hypertensive emergency. When this occurs, blood pressure must be reduced immediately to prevent organ damage. This is done in an intensive care unit of a hospital.

Organ damage associated with hypertensive emergency may include:

· Changes in mental status such as confusion or coma (encephalopathy).

· Bleeding into the brain (stroke).

· Heart failure.

· Chest pain (angina).

· Fluid in the lungs (pulmonary edema).

· Heart attack.

· Aneurysm (Bulging blood vessel).

· Eclampsia (occurs during pregnancy).

Fortunately, hypertensive emergency is rare. When it does occur, it is often when hypertension goes untreated or if the patient does not take his or her medication.

Symptoms of Hypertensive Emergency

Symptoms include:

· Headache

· Seizure

· Chest pain

· Shortness of breath

· Swelling or edema (fluid buildup in the tissues)

Diagnosing Hypertensive Emergency

The health care provider will ask you several questions to get a better understanding of your medical history. He or she will also need to know all medications you are taking including nonprescription and recreational drugs. Also, be sure to tell them if you are taking any herbal or dietary supplements.

Certain tests will be given to monitor blood pressure and assess organ damage, including:

· Regular monitoring of blood pressure.

· Eye exam to look for swelling and bleeding.

· Blood and urine testing.

What's the Treatment for Hypertensive Emergency and Associated Organ Damage?

The first goal is to bring down the blood pressure as quickly as possible with intravenous (IV) blood pressure medications to prevent further organ damage. Whatever organ damage that has occurred is treated with therapies specific to the organ that is damaged.

High Blood Pressure: Which Type Do You Have?

High blood pressure, also known as hypertension, is classified as "essential (primary)" or "secondary.†Essential hypertension does not have an apparent cause. It may be due to such things as genetics (family members who have the disease) or lifestyle. Most people with high blood pressure have essential hypertension.

Secondary hypertension, on the other hand, is less common and is the result of another condition, such as:

· Disorders of the adrenal gland (small organs, located above the kidneys, that create hormones), including Cushing's syndrome (a condition caused by an overproduction of cortisol); hyperaldosteronism (too much aldosterone); and pheochromocytoma (a rare tumor that causes

oversecretion of hormones like adrenaline)

· Kidney disease which may include polycystic kidney disease, kidney tumor, kidney failure, or a narrow or blocked main artery supplying the kidney

· Drugs such as corticosteroids (anti-inflammatory drugs like prednisone), nonsteroidal anti-inflammatory drugs (Motrin, Aleve, Naprosyn, Celebrex), weight loss drugs (such as Meridia) , cold medications that include decongestants, like pseudoephedrine, birth control pills

(the estrogen component), and migraine medications (such as Imitrex)

· Sleep apnea, a condition in which a person has brief spells in which he stops breathing during sleep. About half of patients with this condition have hypertension.

· Coarctation of the aorta, a birth defect in which the aorta is narrowed

· Preeclampsia- a condition related to pregnancy

· Thyroid and parathyroid problems

How Is Secondary Hypertension Diagnosed?

After you are diagnosed with hypertension, your doctor may perform other tests such as blood and urine screening to make sure you don't have secondary hypertension.

 

How Is Secondary Hypertension Treated?

In order to treat secondary hypertension, your doctor will address the condition or disorder that is causing the hypertension (adrenal gland disorder, kidney disease, sleep apnea, etc.) and try to correct that.

In some cases, this may mean that you will have to undergo surgery; for example, if you have a kidney disorder. Not all patients will be eligible for surgery, however. Your doctor may also choose to treat you with antihypertensive drug therapy, whether or not you have surgery.

If you have secondary hypertension that is caused by a drug, your doctor may suggest that you stop taking that drug.

Hypertension: High Blood Pressure and Stroke

A stroke, sometimes called a "brain attack," occurs when blood flow to an area in the brain is cut off. As a result, the brain cells, deprived of the oxygen and glucose needed to survive, die. If not caught early, permanent brain damage can result.

People who have hypertension are 4 to 6 times more likely to have a stroke. Over time, hypertension leads to atherosclerosis and hardening of the large arteries. This, in turn, leads to blockage and weakening of the walls of small blood vessels in the brain, causing them to balloon and burst. The risk of stroke is directly related to how high the blood pressure is.

How Does a Stroke Occur?

There are two types of stroke.

· Ischemic stroke is similar to a heart attack, except it occurs in the blood vessels of the brain. Clots

can form either in the brain's blood vessels, in blood vessels leading to the brain or even blood vessels elsewhere in the body which then travel to the brain. These clots block blood flow to the brain's cells. Ischemic stroke can also occur when too much plaque (fatty deposits and cholesterol) clogs the brain's blood vessels. About 80% of all strokes are of this nature.

· Hemorrhagic (heh-more-raj-ik) strokes occur when a blood vessel in the brain breaks or ruptures. The

result is blood seeping into the brain tissue, causing damage to brain cells. The most common causes of hemorrhagic stroke are high blood pressure and brain aneurysms. An aneurysm is a weakness or thinness in the blood vessel wall that causes it to balloon outward.

 

Warning Signs of Stroke

If you experience any of the following symptoms, call 911 immediately.

· Sudden numbness or weakness in the face, arm, or leg (especially on one side of the body)

· Sudden blurred vision or decreased vision in one or both eyes

· Sudden inability to move part of the body (paralysis)

· Sudden dizziness or headache with nausea and vomiting

· Difficulty speaking or understanding words or simple sentences

· Difficulty swallowing

· Dizziness, loss of balance, or poor coordination

· Brief loss of consciousness

· Sudden confusion

A transient ischemic attack (TIA), often called a “mini-stroke,†is a warning of an impending stroke. It typically consists of the same signs and symptoms of stroke, but the symptoms are temporary. It occurs when blood flow to a certain part of the brain is cut off for a short period of time, usually 15 minutes or less. A TIA can occur anywhere from a few minutes to several months before a stroke. A TIA is a painless episode, but it is a warning that something is wrong. It should be treated as seriously as a stroke.

How Is Stroke Treated?

The only FDA-approved treatment for acute ischemic (sudden onset) stroke is a thrombolytic agent or “clot buster†medication called tPA. tPA must be given within the first 3 hours of the onset of stroke symptoms. Also, there are several new and experimental drugs that may stop -- and even reverse -- the brain damage associated with stroke if administered immediately after a stroke.

Other treatments focus on treating risk factors associated with stroke such as atherosclerosis and high blood pressure. Treatment of high blood pressure is the most important way to prevent stroke.

Are Strokes Preventable?

Up to 50% of all strokes are preventable. Many risk factors can be controlled before they cause problems. Some controllable risk factors include:

· High blood pressure (High = greater than 140/90)

· Atrial fibrillation (a heart condition)

· Uncontrolled diabetes

· High total cholesterol (greater than 200)

· Smoking

· Alcohol (more than one drink per day)

· Being overweight

· Existing carotid and/or coronary artery disease

To prevent stroke it is very important to take measures to lower blood pressure and cholesterol if they are elevated, control diabetes, quit smoking, and get plenty of exercise, and maintain a healthy weight. People at risk for stroke and heart attack may also be treated with aspirin or similar medications, which can prevent blood clots from forming. Some people may need to undergo procedures to remove plaque from the arteries or widen the arteries to improve blood flow.

Summary of Important Facts About Stroke

· Stroke is the leading cause of disability.

· Stroke is the third leading cause of death.

· Stroke is preventable by the control of risk factors.

· Stroke is treatable, but patients must seek immediate medical care.

· All persons should be aware of the signs and symptoms of stroke

Hypertension-Related Kidney Disease

Hypertension is a major cause of kidney disease and kidney failure (end-stage renal disease). Hypertension can cause damage to the blood vessels and filters in the kidney, making removal of waste from the body difficult.

What Are the Symptoms of Kidney Disease?

The symptoms of kidney disease include:

· Hypertension.

· Decrease in amount of urine or difficulty urinating.

· Edema (fluid retention), especially in the lower legs.

· A need to urinate more often, especially at night.

How Is Kidney Disease Diagnosed?

As with hypertension, you may not realize that you have kidney disease. Certain laboratory tests can indicate whether your kidneys are eliminating waste products properly. These tests include serum creatinine and blood urea nitrogen (BUN); elevated levels of either can indicate kidney damage. Proteinuria, an excess of protein in the urine, is also a sign of kidney disease.

Who Is At Risk for Hypertension-Related Kidney Disease?

Hypertension-related kidney disease affects every group and race. However, certain groups are at higher risk, including:

· African-Americans.

· Hispanic-Americans.

· Native Americans.

· Natives of Alaska.

· People who have diabetes.

· People with a family history of hypertension and kidney disease.

How Can I Prevent Kidney Disease?

To prevent hypertension-related kidney damage:

· Try to keep your blood pressure below 130/80.

· Make sure you get your blood pressure checked on a regular basis.

· Eat a proper diet.

· Take the medication your doctor prescribes.

How Is Kidney Disease Treated?

For patients who have hypertension and kidney disease, the most important treatment is to control your blood pressure. ACE inhibitor and angiotensin II receptor blocker drugs lower blood pressure and protect the kidneys from further damage.

Hypertension: High Blood Pressure and Eye Disease

In addition to causing heart and kidney problems, untreated hypertension can also affect your eyesight and cause eye disease. Hypertension can cause damage to the blood vessels in the retina, the area at the back of the eye where images focus. This eye disease is known as hypertensive retinopathy. The damage can be serious if hypertension is not treated.

What Are the Symptoms of Hypertensive Retinopathy?

Most often a person will not experience symptoms, and the retinopathy is found on routine eye exam.

Symptoms include:

· Headaches

· Vision problems

How Is Hypertensive Retinopathy Diagnosed?

An eye care professional can diagnose hypertensive retinopathy. The professional will use an ophthalmoscope, an instrument that projects light, to examine the back of your eyeball. Signs of retinopathy include:

· Narrowing of blood vessels.

· Fluid oozing from the blood vessels.

· Spots on the retina known as cotton wool spots and exudates.

· Swelling of the macula and optic nerve.

· Bleeding in the back of the eye.

How Is Hypertensive Retinopathy Treated?

The best way to treat hypertensive changes to the eye is to adequately control your blood pressure.

Can Hypertensive Retinopathy Be Prevented?

To prevent hypertensive retinopathy, keep your blood pressure in control by changing your diet, exercising more, and taking your high blood pressure medications as prescribed. In addition, see your doctor on a regular basis for follow-up care.

Hypertension: Hypertensive Heart Disease

Hypertensive heart disease is the No. 1 cause of death associated with hypertension and is actually a group of disorders that include heart failure, ischemic heart disease, and left ventricular hypertrophy (excessive thickening of the heart muscle).

What Is Heart Failure?

Heart failure does not mean the heart has stopped working. Rather, it means that the heart's pumping power is weaker than normal or the heart has become less elastic. With heart failure, blood moves through the heart and body less effectively and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart respond by stretching to hold more blood to pump through the body. This helps to keep the blood moving, but in time, the heart muscle walls weaken and are unable to pump as strongly. As a result, the kidneys often respond by causing the body to retain fluid (water) and sodium. If fluid builds up in the arms, legs, ankles, feet, lungs,

or other organs, the body becomes congested, and congestive heart failure is the term used to describe the condition.

Hypertension brings on heart failure by causing coronary artery disease and left ventricular hypertophy. Symptoms of heart failure include:

· Shortness of breath

· Swelling in the feet, ankles, or abdomen

· Difficulty sleeping flat in bed

· Bloating

· Irregular pulse

· Nausea

· Fatigue

· Greater need to urinate at night

What Is Ischemic Heart Disease?

Hypertension can also cause ischemic heart disease. This means that the heart muscle isn't getting enough blood. Ischemic heart disease is usually the result of atherosclerosis or hardening of the arteries (coronary artery disease), which impedes the blood flow. This can progress to a heart attack. Symptoms of ischemic heart disease may include:

· Chest pain which may radiate (travel) to the arms, back, neck, or jaw

· Chest pain with nausea, sweating, shortness of breath, and dizziness; these associated symptoms may also occur without chest pain

· Irregular pulse

· Fatigue and weakness

Any of these symptoms warrant immediate medical evaluation.

What Is Hypertrophic Cardiomyopathy?

Hypertrophic cardiomyopathy is a condition in which the muscular walls of the heart are thickened. This can prevent the heart valves from functioning normally or may keep blood from flowing out of the heart. It usually occurs independently of high blood pressure.

Symptoms of hypertrophic cardiomyopathy may include:

· Chest pain

· Irregular pulse

· Rapid heartbeat

· Shortness of breath

· Fatigue, weakness

· Fainting

Learn more about hypertrophic cardiomyopathy

How Is Hypertensive Heart Disease Diagnosed?

Your doctor will look for certain signs, including:

· High blood pressure

· Enlarged heart and irregular heartbeat

· Fluid in the lungs or lower extremities

· Unusual heart sounds

Your doctor may perform tests to determine if you have hypertensive heart disease, including a electrocardiogram, echocardiogram, cardiac stress test, chest X-ray, and coronary angiogram.

How Is Hypertensive Heart Disease Treated?

In order to treat hypertensive heart disease, your doctor has to treat the hypertension that is causing it. He or she will treat it with a variety of medications, including diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, angiotensin II receptor blockers, and vasodilators.

In addition, your doctor may advise you to make changes to your lifestyle, including:

· Diet: If heart failure is present, lowering the total amount of sodium to 2,000 mg or 2 g or less per

day; eating foods high in fiber and potassium; limiting total daily calories to lose weight if necessary; and limiting foods that contain refined sugar, saturated fats, and cholesterol.

· Monitoring your weight: This involves daily recording of weight; increasing your activity level (as

recommended by your doctor); resting between activities more often; planning your activities.

· Avoiding tobacco products and alcohol

· Regular medical checkups: During follow-up visits, your doctor will make sure you are staying healthy

and that your heart disease is not getting worse.

In some cases, you may need surgery to correct the heart disease. Surgeries include coronary bypass grafting (to bypass clogged heart arteries), mitral valve repair (to repair a leaky valve caused by cardiomyopathy or ischemia), vascular surgeries (to repair defects of the blood vessels), and implantation of a left ventricular assist device (to improve pumping if you have heart failure as a bridge to heart transplantation).

Hypertension: Treatment Overview

Hypertension, or high blood pressure, is dangerous because it can lead to strokes, heart attacks, heart failure, or kidney disease. The goal of hypertension treatment is to lower high blood pressure and protect important organs, like the brain, heart, and kidneys from damage. Treatment for hypertension has been associated with reductions in stroke (reduced an average of 35%-40%), heart attack (20%-25%), and heart failure (more than

50%), according to research.

Hypertension is classified as:

· Normal blood pressure: less than 120/80 mmHg

· Prehypertension: 120-139/80-89 mmHg

· Hypertension: greater than 140/90 mmHg

· Stage 1 Hypertension:140-159/90-99 mmHg

· Stage 2 Hypertension: 160 or greater/ 100 or greater mmHg

All patients with blood pressure readings greater than 120/80 should be encouraged to make lifestyle modifications, such as eating a healthier diet, quitting smoking and getting more exercise. Treatment with medication is recommended to lower blood pressure to less than 140/90 mmHg. For patients who have diabetes or chronic kidney disease the recommended blood pressure is less than 130/80 mmHg.

Treating hypertension involves lifestyle changes and drug therapy.

Lifestyle Changes

A critical step in preventing and treating hypertension is a healthy lifestyle. You can lower your blood pressure with the following lifestyle modifications:

· Losing weight if you are overweight or obese.

· Quitting smoking.

· Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy

products, less saturated and total fat).

· Reducing the amount of sodium in your diet to 2,300 milligrams (about 1 teaspoon of salt) a day or less.

· Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week).

· Limiting alcohol to two drinks a day for men, one drink a day for women.

In addition to lowering blood pressure, these measures enhance the effectiveness of antihypertensive medications.

Medications

There are several types of drugs used to treat hypertension, including:

· Angiotensin-converting enzyme (ACE) inhibitors

· Angiotensin || receptor blockers (ARBs)

· Diuretics

· Beta-blockers

· Calcium channel blockers

Diuretics are usually recommended as the first line of therapy for most people who have hypertension. If one drug doesn't work or is disagreeable, other types of diuretics are available.

However, your doctor may start a medicine other than a diuretic as the first line of therapy if you have certain medical problems. For example, ACE inhibitors are often a good choice for a people with diabetes.

If your blood pressure is more than 20/10 mmHg higher than it should be, your doctor may consider starting you on two drugs.

Follow-Up

After starting antihypertensive drug therapy, you should see your doctor at least once a month until the blood pressure goal is reached. Once or twice a year, your doctor will check your serum potassium (diuretics can lower this, and ACE inhibitors and ARBs may increase this) and magnesium and BUN/creatinine levels (to check the health of the kidneys).

After the blood pressure goal is reached, you should continue to see your doctor every three to six months, depending on whether other diseases such as heart failure are present.

TREATMENT DRUGS

HYDROCHLOROTHIAZIDE - ORAL

This medication is used to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Hydrochlorothiazide is a "water pill" (diuretic) that causes your body to get rid of extra salt and water. This increases the amount of urine you make.

This medication also reduces extra fluid in the body (edema) caused by conditions such as congestive heart failure, liver disease, and kidney disease. Getting rid of extra water helps to reduce fluid in the lungs so that you can breathe easier. It also helps to decrease swelling of the arms, legs, and stomach/abdomen.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This medication may also be used to treat a condition known as "water diabetes" (diabetes insipidus) and to help prevent calcium kidney stones.

How to use Hydrochlorothiazide Oral

Take this medication by mouth with or without food, usually once daily or as directed by your doctor. The dosage is based on your medical condition and response to therapy.

It is best to avoid taking this medication within 4 hours of your bedtime to avoid having to get up to urinate. Consult your doctor or pharmacist if you have questions about your dosing schedule.

Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time each day or as prescribed. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick. Do not stop taking this medication without consulting your doctor.

Dizziness, lightheadedness, headache, blurred vision, loss of appetite, stomach upset, diarrhea, or constipation may occur as your body adjusts to the medication. You may also experience decreased sexual ability or increased sensitivity to the sun. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may cause a loss of too much body water (dehydration) and salt/minerals. Tell your doctor immediately if you have any of these unlikely but serious symptoms of dehydration or mineral loss: very dry mouth, thirst, muscle cramps, weakness, fast/irregular heartbeat, nausea, vomiting, severe dizziness, unusual drowsiness, unusual decrease in the amount of urine, fainting, confusion, seizures.

Tell your doctor immediately if any of these unlikely but serious side effects occur: numbness/tingling of the arms/legs, joint pain (e.g., big toe pain).

Tell your doctor immediately if any of these rare but very serious side effects occur: signs of infection (e.g., fever, persistent sore throat), easy bruising/bleeding, stomach/abdominal pain, persistent nausea/vomiting, unusual/persistent tiredness, yellowing eyes/skin, dark urine, unusual change in the amount of urine (not including the normal increase in urine when you first start this drug).

A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Hypertension: Treatment with Calcium Channel Blockers

Calcium channel blockers are medications used to lower blood pressure. They work by slowing the movement of calcium into the cells of the heart and blood vessel walls, which makes it easier for the heart to pump and widens blood vessels. As a result, the heart doesn't have to work as hard, and blood pressure lowers.

Examples of calcium channel blockers include:

· Norvasc (amlodipine)

· Plendil (felodipine)

· DynaCirc (isradipine)

· Cardene (nicardipine)

· Procardia XL, Adalat (nifedipine)

· Cardizem, Dilacor, Tiazac, Diltia XL (diltiazem)

· Isoptin, Calan, Verelan, Covera-HS ( verapamil)

Side Effects

Potential side effects from taking a calcium channel blocker include:

· Dizziness or lightheadedness.

· Low blood pressure.

· Heart rhythm problems particularly.

· Dry mouth.

· Edema (swelling of ankles, feet, or lower legs).

· Headache.

· Nausea.

· Fatigue.

· Skin rash.

· Constipation or diarrhea.

Medication Guidelines

Before taking a calcium channel blocker, tell your doctor:

· About any medical conditions you have, including any heart or blood vessel disorders, kidney or liver disease.

 

· About every medication you are taking, including any over-the-counter or herbal medications. Certain drugs may interact with calcium channel blockers.

How Should I Take Calcium Channel Blockers?

Take this medication with food or milk. Follow the label directions on how often to take it. The number of doses you take each day, the time allowed between doses and how long you need to take the medicine will depend on the type of medication prescribed and on your condition.

While taking this medication, your doctor may tell you to take and record your pulse daily. Your doctor will tell you how rapid your pulse should be. If your pulse is slower than advised, contact your doctor about taking your medication that day.

Be sure to see your doctor on a regular basis to make sure the medicine is working as it should and isn't causing any intolerable side effects. Your doctor may want to change the dosage if the drug isn't having the intended effect.

Food and Drug Interactions

Do not eat grapefruit or drink grapefruit juice while taking a calcium channel blocker.

· Do not drink alcohol while taking a calcium channel blocker. Alcohol interferes with the effects of the drug and increases the side effects.

· Taking other blood pressure medications in combination with a calcium channel blocker may cause a sudden drop in blood pressure. Discuss with your doctor the best way to take the medication if you are taking other drugs.

Hypertension: Treatment with Beta Blockers

Beta-blockers are medications used to treat hypertension. They block the effects of the sympathetic nervous system on the heart. This reduces the work of the heart so that it requires less blood and oxygen. As a result, the heart doesn't have to work as hard, which in turn lowers blood pressure. They help control heart rate and are also used in the treatment of abnormal heart rhythms that may too fast or

irregular.

There are several beta-blockers available, including:

· Sectral (acebutolol)

· Tenormin ( atenolol)

· Kerlone (betaxolol)

· Zebeta (bisoprolol)

· Coreg (carvedilol)

· Normodyne, Trandate (labetalol)

· Lopressor, Toprol-XL (

Hypertension: Diuretic Treatment

Diuretics, commonly known as "water pills," help your body get rid of unneeded water and salt through the urine. Getting rid of excess salt and fluid helps lower blood pressure and can make it easier for your heart to pump. Diuretics may be used to treat a number of heart-related conditions, including high blood pressure, heart

failure, kidney and liver problems, and glaucoma. Examples of diuretics include:

· Esidrix ( hydrochlorothiazide

also commonly known as HCTZ)

· Lasix ( furosemide)

· Bumex (bumetanide)

· Demadex (torsemide)

· Zaroxolyn (metolazone)

· Aldactone (spironolactone)

Diuretics are categorized as thiazide-like (Zaroxolyn and Esidrix), loop (Lasix, Bumex) or potassium-sparing (Aldactone). Thiazide diuretics provide the most effect on lowering blood pressure, cause moderate increases in sodium excretion, and are appropriate for long-term use. Loop diuretics are more powerful and are often used when people have congestive heart failure symptoms and are especially useful in emergencies. Potassium-sparing diuretics help your body retain potassium are used more often in congestive

heart failure patients and are often prescribed in conjunction with the other two types of diuretics.

What Are the Side Effects?

Frequent urination. This may last for several hours after a dose.

· Arrhythmia (abnormal heart rhythm)

· Electrolyte abnormalities- Blood test monitoring of electrolytes is important before and during the taking of these medications.

· Extreme tiredness or weakness. These effects should decrease as your body

adjusts to the medication. Call your doctor if these symptoms persist.

· Muscle cramps or weakness. Be sure that you are taking your potassium

supplement correctly, if prescribed. Contact your doctor if these symptoms persist.

· Dizziness, lightheadedness. Try rising more slowly when getting up from a lying or sitting position.

· Blurred vision, confusion, headache, increased perspiration (sweating), and restlessness. If these effects are persistent or severe, contact your doctor.

· Dehydration. Signs include dizziness, extreme thirst, excessive dryness of the mouth, decreased urine output, dark-colored urine or constipation. If these symptoms occur, don't assume you need more fluids, call your doctor.

· Fever, sore throat, cough, ringing in the ears, unusual bleeding or bruising, rapid and excessive weight loss. Contact your doctor right away.

· Skin rash. Stop taking the medication and contact your doctor right away.

· Loss of appetite, nausea, vomiting or muscle cramps. Be sure that you are taking your potassium supplement correctly, if prescribed.

Rarely, potassium-sparing diuretics like Aldactone can cause breast enlargement in men and women, deepening of the voice, increased hair growth and irregular menstrual cycles.

Contact your doctor if you have any other symptoms that cause concern.

Medication Guidelines

· Before this medication is prescribed, tell your doctor if you are taking any other medications that may have been prescribed by another physician or any over-the-counter or herbal remedies. Also, tell your doctor if you have any other medical problems.

 

· Follow the your physician’s instructions on how often you should take the diuretic. If you are taking a single dose a day, it might be better to take it in the morning instead of at night, so that you will not have your sleep interrupted by frequent trips to the bathroom. (This is more pertinent for patients with CHF or cirrhotic patients with portal hypertension.)

· While taking this medication, have your blood pressure and kidney function tested regularly, as advised by your doctor.

· Keep all appointments with your doctor and the laboratory so that your response to this medication can be monitored.

Food or Drug Interactions

Diuretics are often prescribed in combination with other blood pressure and heart medications as a single pill. This could increase the effects of these other medications or contribute to abnormalities in your electrolyte levels, such as potassium.

If you experience an increase in side effects after taking your medications together, contact your doctor. You may need to change the times you are taking each medication.

Follow your doctor's dietary advice, which may include:

· Following a low-sodium diet.

· Taking a potassium supplement or including high-potassium foods (such as bananas and orange juice). Note: some types of diuretics cause your body to lose potassium.

· If you are taking a "potassium-sparing" diuretic, such as Aldactone, your doctor may want you to avoid potassium-rich foods, salt substitutes, low-sodium milk and other dietary sources of potassium.

Alcohol and sleep aids may increase the side effects of this medication and should be avoided.