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Medicines for high blood pressure
Why are different people given different medicines?
Different people respond differently to medication depending on which ethnic group they come from, their age and how much salt they are eating.
It has been found that there is a slightly better response in younger, non-black people (not of African origin) to treatment with ACE inhibitors and angiotensin receptor blockers. Older people and those of African origin respond better to calcium-channel blockers and thiazide diuretics. Therefore the possibility that blood pressure can be controlled using just one drug is greater if these drugs are used as a first choice in each of these groups.
However if you are prepared to reduce your salt intake, even if you are older or of African origin, you may get as good a response from an ACE inhibitor or an angiotensin receptor blocker as you would from the calcium-channel blocker or thiazide diuretic.
The underlying mechanism for this is a hormonal system called the Renin Angiotensin System, which is an important control of blood pressure and tends to be more important in controlling blood pressure in younger people and in those who have restricted their salt intake. Two drug classes, ACE inhibitors and angiotensin receptor blockers, block this hormonal system and therefore are more effective in this group.
It is important to realise that these differences are small in many individuals and the important thing is to take sufficient medication (in most people this will be two, or more often three, medicines) to get really good control of blood pressure.
Can I ever come off tablets once I start taking them?
For almost everyone the answer to this is no. Once you find out you have high blood pressure and need tablets, it is very likely that you will have to take the tablets for the rest of your life. In a small number of people, particularly those who really stick to the lifestyle measures, it may be possible to reduce or stop some of the medications.
When people stop their blood pressure medication, eventually most have to go back on them. Do not stop them as soon as your blood pressure is controlled - within a few weeks it will be back up again and there is no point in only reducing your blood pressure for a few months. High blood pressure is something that affects you in the long-term and, therefore, it is very important to keep it controlled over the long-term and to keep taking the tablets.
Should I be taking aspirin as well?
If you have high blood pressure you should only take aspirin if you have an increased risk of a heart attack or stroke and only when your blood pressure is well controlled. You should talk to your doctor before starting aspirin.
The reason for this is that aspirin affects the way your blood clots and is therefore more likely to cause bleeding from the stomach and intestines. Aspirin may also be linked to an increased risk of strokes from bleeding directly into the brain.
You should not take aspirin yourself regularly unless your doctor has said that it is right for you to take it.
Does it matter what time of day I take my medicines?
It is best to take your medication at a regular time each day so that it becomes part of your routine. It doesn’t really matter whether you take it in the morning or the evening; it’s whatever suits you best. Water tablets (diuretics) may sometimes increase the number of times you need to pass urine, particularly when you first start them, so take them when you find it most convenient, when you first get up in the morning for example.
My medication is not working – what can I do?
If you are taking just one tablet, your GP may switch you to another tablet. However, if the first tablet you try has lowered your blood pressure and you feel well, but it is not at the target level, then your GP will probably add in a second medicine. Both tablets work better together than they would have done alone. For most people taking two or three different tablets is normal in helping to get good control of blood pressure. If your blood pressure is still not well controlled, your doctor may add in other medications or try different groups of medications until you reach your target level. Once your blood pressure is controlled, you should then be able to stay on the same tablet or combination of tablets for a very long period of time with good control of your blood pressure. Remember that changes in lifestyle, particularly reducing salt intake, make the tablets much more effective.
Should I spread out taking my pills across the day?
Most blood pressure lowering drugs are long-acting and can be taken just once a day. There is no convincing evidence that benefits are obtained from taking your different tablets at different times throughout the day. It is really a matter of convenience. The most important thing is to make sure that you take each tablet at the same time every day so that the blood pressure lowering effect covers the full 24 hours.
Some people find it more convenient to take their tablets in the evening when they get home from work. This avoids forgetting your pills in the hurly burly of getting up and getting ready for the day in the early morning. In the end, it is a matter of personal choice. The most important thing is to maintain a routine and take your tablets regularly.