Doctor’s Tip: Medications for high blood pressure

Dr. Greg Feinsinger
Doctor’s Tip
Greg Feinsinger
Mark Burrows

Last week’s column pointed out that when large groups of people are studied, the subgroups with blood pressures of 110/70 or less have the healthiest arteries — which contributes to healthy hearts, brains and kidneys. Heart attack prevention doctors such as Bale and Doneen, authors of “Beat the Heart Attack Gene,” want their patients’ blood pressures to be at least 120/80 or less.

Regular exercise contributes to lower blood pressure. And last week’s column discussed how diet is related to blood pressure.

However, realistically not everyone is willing to exercise regularly and eat a plant-based, unprocessed food diet with no salt, sugar or added oil. Furthermore, a small percentage of people on a perfect diet and exercise regimen still have blood pressures above goal — often for genetic reasons.

Fortunately for those people, many effective medications, some with few to no side effects, are now available.

If you are diagnosed with high blood pressure, you should be checked for sleep apnea, a common cause. It is also important to determine if you are on drugs that can cause or contribute to hypertension, such as certain antidepressants; NSAIDS (ibuprofen, naproxen, etc. — but not aspirin); certain birth control pills; cortisone; decongestants; excessive caffeine; and excessive alcohol.

Many patients resist taking blood pressure pills because of the misconception that once you start blood pills you can’t get off of them. Of course, if people don’t change their lifestyle their hypertension will persist, but if they do, often their hypertension will resolve and they no longer need blood pressure pills. While you’re waiting for lifestyle changes to kick in, it’s important to control your BP with pills, because every day you have untreated hypertension, arterial damage is occurring. My own experience is that a month after going on a plant-based diet 10 years ago, I lost 12 pounds, no longer had hypertension, and was able to stop my blood pressure pill — my blood pressure now runs around 105/70.

Following is a brief overview of commonly prescribed blood pressure medications:

• ACE (angiotensin converting enzyme) inhibitors: These prevent the kidneys of people with hypertension from making too much angiotensin — a hormone that constricts blood vessels, raising blood pressure. ACE inhibitors became available years ago, and as Bale and Doneen say, “[users] show significant reductions in heart attacks, strokes, heart failure, and kidney failure,” and help prevent diabetes. People with chronic kidney disease or diabetes should be on ACEs, regardless of their blood pressures. Rare allergic reactions can occur, and 10 percent of users have a dry hacky cough — annoying but not serious. Lisinopril is most commonly prescribed, but ramipril has the best data for stabilizing arterial plaque.

• ARBs (angiotensin receptor blockers) such as losartan, came out several years after ACEs did. They prevent the constricting action of angiotensin on blood vessels. Side effects, including cough, are very rare. However, the disease-prevention data isn’t as impressive as with ACEs. Bale and Doneen recommend that doctors start hypertensive patients on an AC inhibitor, and move to an ARB only if they develop a cough.

• Calcium channel blockers such as amlodipine lower blood pressure by causing cells in the walls of arteries to relax. Amlodipine in high doses can cause leg swelling.

• Thiazide diuretics decrease excess water and sodium in your body, which reduces blood pressure. High doses were used decades ago, before other medications were developed, resulting in low potassium, rise in blood sugar and sexual dysfunction. Low doses such as 12.5 mg of HCTZ (hydrochlorothiazide) have a lower side effect rate. Chlorthalidone has better 24-hour coverage than HCTZ, but HCTZ is often used in combination with ACE inhibitors (e.g. lisinopril/HCTZ) and ARBs to improve effectiveness and to help prevent potassium loss. If someone’s blood pressure is over 150 or so, an ACE alone is unlikely to get it to goal, whereas lisinopril/HCTZ 20/12.5 most likely will. If you start a diuretic, sodium and potassium levels should be checked after two to four weeks and then every six months thereafter.

• Beta blockers: Just because a drug lowers blood pressure doesn’t automatically mean that it prevents heart attacks and strokes, and the beta blocker atenolol is an example of that. Some other beta blockers do have positive outcome data, however. Beta blockers block adrenaline, causing your heart to beat more slowly and less forcefully. Common side effects are tiredness, depression, low exercise tolerance, and worsening of insulin resistance/pre-diabetes. Carvedilol and nebivolol are the only two beta-blockers that don’t worsen insulin resistance and are the only ones that should be used in people with diabetes or pre-diabetes. Some experts argue that they are the only beta blockers that should be used for blood pressure lowering, because they dilate arteries.

Bottom line: To prevent disability and premature death, your blood pressure should be 120/80 or below. The most effective and certainly safest way to achieve this is to maintain ideal body weight; exercise regularly; avoid salt; and eat plant-based, unprocessed food. If you’re unwilling to do that, don’t hesitate to take blood pressure pills.

Retired physician Greg Feinsinger, M.D., is author of new book “Enjoy Optimal Health, 98 Health Tips From a Family Doctor,” available on Amazon and in local bookstores. Profits go towards an endowment to the University of Colorado School of Medicine to add prevention and nutrition to the curriculum. He is available for free consultations about heart attack prevention, diabetes reversal, nutrition, and other health issues. Call 379-5718 for an appointment. For questions about his column, email

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