Control your Blood Pressure with or without medications. Learn how and choose what is best for you

Our circulatory system (blood pressure system) is like a closed system of pipes with fluid inside it. The proteins, salts, heart contractions, the elasticity of the blood vessels, nerve supply and hormones control the blood pressure within certain limits.

Blood pressure medications work on different parts of the body system or by decreasing the amount of available circulating fluid. This is a very detailed lecture and includes lots of information. Please pay particular attention on the effect of the medication and also the dosage. Accurate adjustment of the dosage is important because “over dosages” will cause hypotension and “under dosages” will cause the patient to remain hypertensive.

Diagram 1. A Nephron. The functional unit of a kidney.

All medications must be prescribed by a duly qualified physician and must be dispensed by a duly qualified pharmacist and administered by a qualified nurse. Student Nurses can administer medications in their third year when under the supervision of a Registered Nurse.

In some situations, it is not necessary to take medications to control blood pressure. Lifestyle changes, reduction of salt intake, exercise program and relaxation may bring about the desired reduction in blood pressure. In the United States, generally speaking, patients whose blood pressure is greater the 150/90 may be prescribed a medication to reduce the blood pressure.

The most common medication used to lower blood pressure is a group of medications called diuretics. These act on the loop of Henle in the nephron of the kidney. They get rid of fluid from the patient’s body. When this happens, the circulating volume is reduced, and the blood pressure falls. Please read the following paragraph and review diagram 1 (above).

A Nephron – The Functional Part of a Kidney.

A nephron is the functional unit of each kidney. This is the place where purification and filtration of the blood takes place. There are approximately one million nephrons in the cortex of a healthy kidney. The kidney receives it’s blood supply from the renal arteries. The renal arteries divide and subdivide continuously until they become the afferent and then the efferent arterioles. The afferent arteriole, shown here in red, carries the blood to be filtered into the Bowman’s capsule. Many needed items like glucose, sodium, amino acids pass through the glomerular-capsule membrane and are reabsorbed by the proximal part of the loop of Henle. It is for this reason that the nephron is often said to part of the homeostatic mechanism of the human body.

Blood Pressure Drugs.

It is best to control blood pressure changes by bringing about life style changes. This is what many of my colleagues who advocate holistic medicine are advocating. However, many a times a patient can stop taking salt, give up cigarettes, stop eating fats, control cholesterol, change job and pray all the time but still remain hypertensive. In these situations medications are indicated and should be used.

In some instances one medication may not be able to bring about the desired result, therefore another medication may be added on or that the prescribed medication has an effect on the body which is not desired. Kypokalemia is one such effect. If this is expected to occur, your doctor my prescribe potassium tablets for you to take each time you take your blood pressure lowering medication.

The first group of blood pressure lowering medications are called diuretics.

Diuretics

Diuretics are sometimes called “water pills” because they work in the kidney to get rid of excess water and sodium from the body, the movement of other electrolytes also occurs but these two are the most important.

Examples: They include Aldactone, Bumex, Demadex, Diuril, Dyrenium, Enduron, Hydrodiuril, Inspra, Lasix, Lozol, Microzide, Midamor, Mykrox, Thalitone, Zaroxolyn.

Table 1. Plain and Potassium sparing Diuretics (above).

Potassium-sparing diuretics are those which expel water but not potassium, from the body. Hence the name. The last three mentioned in the column above are potassium sparing diuretics. Some authorities do not consider Potassium sparing Diuretics to be effective.

Table 2. Combinaton diuretics (above).

Combinations diuretics are diuretics those which have more than one active ingredient. The reason for this is that potassium-sparing diuretics are not considered to be effective. Consequently, in the U.S. Hydrochlorothiazide is nearly always combined into a single tablet with one of the other diuretics, see table for details. Combination diuretics are thought to be comparably effective and are used extensively. These are shown in table 2, above.

Beta blockers.

This is a large group of medications. It has been referred to differently in different literature. The term beta-adrenergic blocking agents, beta-blocking agents or beta-blockers refer to this group of medications. Beta-blockers reduce nerve impulses to the heart and blood vessels. This makes the heart beat slower and with less force. Blood pressure drops and the heart works less hard, thus conserving lots of energy.

Sometimes, beta-blockers are also used to correct heart arrhythmias, treat migraines, and tremors.

Table 3. Commonly used Beta Blockers in the management of hypertension (above).

Diagram 2: Regulating Blood Pressure: The Renin-Angiotensin-Aldosterone System

When the blood vessels contract the blood pressure rises. This causes hypertension. Angiotensin II is the chemical which brings about this contraction. It is produced from angiotensin I in the blood by the enzyme ACE. ACE inhibitors are medications which slow or inhibit the activity of the enzyme, which decreases the production of angiotensin II. The end result is that peripheral blood vessels dilate bring about a reduction of the blood pressure. The lowered blood pressure makes it easier for the heart to pump and it is for this reason the ACE inhibitors are also used in the management of a failing heart, and preventing kidney damage. Commonly used ACE inhibitors are listed below, in table 4.

Table 4. Commonly used ACE inhibitors (above).

Angiotensin antagonists.

Angiotensin antagonists are a new group of medications which are used for the treatment and management of high blood pressure (hypertension). These medications shield blood vessels from the constricting action of angiotensin II. Consequently, blood vessels become dilated and blood pressure falls to normal levels. A list of Angiotensin antagonists is given in table 5, below. Commonly used Angiotensin antagonists include candesartan (atacand) irbesarten (Avapro) losartin potassium (cozaar) valsartan (Diovan)

Calcium Channel blockers (CCBs).

CCBs keep calcium from entering the muscle cells of the heart and blood vessels. This causes the blood vessels to relax and pressure goes down. Commonly used CCBs are amlodipine besylate (Norvasc) diltiazem hydrochloride, felodipine (Plendil) isradipine, nicardipine, nifedipine, nisodipine, and verapamil hydrochloride (calan).

Alpha Blockers.

Alpha-blockers reduce nerve impulses to blood vessels, which allow blood to pass more easily, causing the blood pressure to go down. Commonly used alpha blockers are shown in table 5, below.

Table 5. Commonly used alpha blockers in the US.

Alpha Beta Blockers.

Alpha-beta-blockers work the same way as alpha-blockers but also slow the heartbeat, as beta-blockers do. As a result, less blood is pumped through the vessels and the blood pressure goes down. Alpha methyldopa (aldomet), clonidine hydrochloride (catapres), guanabenz acetate (Wytensin) are commonly used alpha beta blockers.

Nervous system inhibitors.

In healthy patients the nervous system controls the degree of constriction or dilatation of blood vessels. Nervous system inhibitors are medications which relax blood vessels by controlling nerve impulses. This causes the blood vessels to become wider and the blood pressure to go down. Guanadrel (Hylorel), reserpine (Serpasil) guanethidine monosulfate (ismelin).

Vasodilators.

These are so called because they dilate the blood vessels of the person taking the medication. This is done by relaxing the muscle in the vessel walls, causing the blood pressure to go down in proportion to the amount of medication which is given. Hydralazine hydrochloride (apresoline), Minoxidil (Loniten).

Holistic approaches which are scientifically proven to work.

1. Reduction is salt intake. This reduces the circulating fluid. Therefore blood pressure falls. Proof: Take a lot of salt, you will drink plenty and your blood pressure will increase because your circulatory system has too much fluid. You can reverse this process and see the results for yourself. You do not need to be a scientist.
2. Regular exercise. Doing exercises will lower your blood pressure. The reasons are two fold. First, the heart becomes stronger and beats more efficiently and secondly the blood vessels become more elastic and therefore have more recoil (elasticity). Proof: Stop exercising for two months and you will loose all the benefits of your exercises.
3. Healthy Diet: Reduce cholesterol and red meat intake. The elasticity of your blood vessels will improve. There will be minimal or no plaque deposits in your blood vessels. This is important because the plaque decreases available space for your blood to travel around the body.
4. Cigarettes: The vasoconstriction brought about by cigarettes increases blood pressure. Coffee and other vasoconstrictors should be avoided.
5. Stress, job related or not, must be reduced. Relaxation has a BP reducing effect on the body.
6. Watch what medications you are taking. Many non-steroidal anti-inflammatory drugs, diet pills, steroids, antidepressants and monoamine oxidase inhibitors are known to be major causes of hypertension.
7. Weight. If you weigh too much your heart has to supply oxygenated blood to all the fat you are carrying. So it has to produce a higher blood pressure, otherwise the oxygenated blood will not reach all the fatty and not so fatty tissues.
8. Alcohol. Research shows that consuming more than 3 to 4 ounces of 80-proof alcohol per day will result in hypertension. One to two drinks per day is considered satisfactory.
9. Question your holistic practitioner’s motives. Does he get a commission on his sale to you. Is there a professional body to verify what he/she is telling you is correct. If in doubt, move on.
10. Do not settle for unproven techniques because there will be no second chance. When tissues die they do not, do not, do not, do not regenerate. This is not a typing error. I am saying that dead tissue does not regenerate. Just like dead people never come back to life!

In conclusion, I must say that one must try all natural holistic methods of controlling blood pressure before resorting to chemical medications. These are costly and must be prescribed and supervised by professionally qualified physicians. In the best interests of the patient, when holistic methods fail, it is best to get early treatment because non-treatment can have disastrous consequences. The diagnosis of hypertension must also be made by a clinical specialist and never on the basis of one high BP reading.