Often, an underlying medical condition requires treatment with medications or surgery. Once an underlying condition is effectively treated, secondary hypertension may decrease or even return to normal. Often, however, lifestyle changes — such as eating healthy foods, increasing physical activity and maintaining a healthy weight — can help keep your blood pressure low.
You may need to continue to take blood pressure medication as well, and any underlying medical condition you have may affect your doctor's choice of medication. ossible drug choices include:
- Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications. These medications are often generic and tend to be less expensive than other high blood pressure medications. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. Possible side effects include an increased need to urinate and a higher risk of sexual dysfunction.
- Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in blacks — but they're effective when combined with a thiazide diuretic. Possible side effects include fatigue, sleep problems, a slowed heart rate, and coldness in your hands and feet. In addition, beta blockers generally aren't prescribed for people with asthma, as they can increase muscle spasms in the lungs.
- Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure. Like beta blockers, ACE inhibitors don't work as well in blacks when prescribed alone, but they're effective when combined with a thiazide diuretic. Possible side effects include dizziness and cough, and these medications aren't recommended during pregnancy.
- Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels. Like ACE inhibitors, angiotensin II receptor blockers often are useful for people with coronary artery disease, heart failure or kidney failure. These medications have fewer potential side effects than do ACE inhibitors, but are also not used during pregnancy.
- Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks than do ACE inhibitors or beta blockers alone. Possible side effects include water retention, dizziness and constipation. And, a word of caution for grapefruit lovers. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Ask your doctor or pharmacist if your medication is affected by grapefruit juice.
- Direct renin inhibitors. Recent treatment for hypertension includes direct renin inhibitors, such as aliskiren. Aliskiren relaxes and widens the arteries by preventing the action of renin. Renin is the initial enzyme in a cascade of steps in the production of chemicals (angiotensin, aldosterone, others) important in cardiovascular health and disease. The Food and Drug Administration strongly cautions against using aliskiren in combination with ACE inhibitors or angiotensin II receptor blockers in people with diabetes or moderate to severe kidney problems. Common side effects of aliskiren include dizziness and diarrhea.
Treatment can sometimes be complicated. You may need more than one medication combined with lifestyle changes to control your high blood pressure. And your doctor will want to see you more frequently until your blood pressure is stabilized, possibly as frequently as once a month.
March 15, 2013
- McKean SC, et al. Principles and Practice of Hospital Medicine. New York, N.Y: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=749. Accessed Jan. 25, 2013.
- Sukor N. Secondary hypertension: A condition not to be missed. Postgraduate Medical Journal. 2011;87:706.
- Kaplan NM, et al. Overview of hypertension in adults. http://www.uptodate.com/home. Accessed Jan. 25, 2013.
- Fuster V, ed. et al. Hurst's The Heart. 13th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=5. Accessed Jan. 25, 2013.
- Lerma EV, et al. Current Diagnosis & Treatment: Nephrology & Hypertension. New York, N.Y.: The McGraw-Hill Companies; 2009. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=628. Accessed Jan. 25, 2013.
- Viera AJ, et al. Diagnosis of secondary hypertension: An age-based approach. American Family Physician. 2010;82:1471.
- Grossman E, et al. Drug-induced hypertension: An unappreciated cause of secondary hypertension. The American Journal of Medicine. 2012;125:14.
- Sheps SG (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 20, 2013.
- The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Bethesda, Md.: National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm. Accessed Jan. 20, 2013.
- Your guide to lowering your blood pressure with DASH. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf. Accessed Jan. 20, 2013.
- Riccioni G. Aliskiren in the treatment of hypertension and organ damage. Cardiovascular Therapeutics. 2011;29:77.
- FDA drug safety communication: New warning and contraindication for blood pressure medicines containing aliskiren (Tekturna). U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/ucm300889.htm. Accessed Jan. 22, 2013.
- Aliskiren. Micromedex Healthcare Series. http://www.micromedex.com. Accessed Jan. 22, 2013.
- Grapefruit. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed Jan. 22, 2013.