Today we’ll be discussing and talking about, and I’ll be describing three different groups of medications, but before I do that I want to make a clarification about the medications that this podcast will be talking about. We’ve talked about high blood pressure, and I’ve used high blood pressure as a condition to describe the medications that we’re currently talking about. And the reason why I chose high blood pressure to describe these medications, is that high blood pressure is probably one of the top five chronic health care conditions that is right now major in the population of the United States. And I thought it would be a good backdrop to describe the medications used to treat high blood pressure, but I also want to make it clear that and I want to make sure people who are on these medications saying “oh Howard he talked about this medication but I don’t have high blood pressure”, not to be concerned. There are many drugs and medications we use today to treat conditions that can be used in other conditions as well. It doesn’t mean that their mechanism of action or how they work, we call that a mechanism of action, changes from one condition to another. We can use medications for a variety of different conditions. I wanted to make that clear so that nobody gets concerned about being treated for something that, my gosh I’m using a drug that isn’t used for that, don’t be concerned and if you again have any questions, please contact your health care provider to explain to you the therapies that you’re on.
So let’s begin again with a description of what blood pressure is. Blood pressure is the pressure required the that the heart push through blood and fluids through the heart into the blood vessels and then pump the fluid in blood through the blood vessels that return back to the heart. There’s a normal range of blood pressure that we find spread throughout the population. High blood pressure occurs is when the blood vessels narrow and as that occurs the heartnow has to put greater pressure contract more forcefully putting greater workload on the heart to increase the amount of pressure to push the same amount of blood and fluid through the heart through those narrow blood vessels, that’s high blood pressure.
Today we’re going to be talking about the beta blockers be BETA blockers we’re going to also be talking about the vasodilators, obviously that name gives it away, and the calcium channel blockers and we’ll get into more detail with that. I want to just mention that the medications today that we are going to be talking about are generally not used as a first line medication, and they’re usually in combination with other medications to treat a variety of different types of conditions. But with respect to blood pressure, they are usually added on to other medications.
Generally, when you treat high blood pressure you do it in a stepwise fashion. The first step would be lifestyle changes, loss of weight, smoking cessation, restricted salt intake, and exercise. If that doesn’t adequately control the blood pressure we moved to another step and we add on a water pill or a diuretic. If that still doesn’t control the blood pressure we then add on other medications. So these three medication groups would be the added on medications to already existing medications that you may be on when treating high blood pressure. Of course all of this is dependent upon your healthcare provider and how they want to treat your specific individual condition.
let’s talk about blockers since we’re going to be talking about two groups that have the name blocker or the word blocker in their group title or description or category. I like to use analogies so let’s think about this as a football game and you have a line blocker, that blocker is used to prevent something from happening for example in the football game obviously a touchdown by blocking a runner. Well, we’re doing the same thing here but we’re blocking a chemical or a hormone or something that a chemical is going to do to create or to prevent your high blood pressure, and that’s what blockers do. So we’re going to be first talking about beta blockers. What the beta blockers do is they block the effect of epinephrine, or another name is adrenaline, you’ve probably heard you know one of those two names. Sometimes you’ll hear the saying oh that person is working off a lot of adrenaline and they’re doing some kind of activity. Adrenaline is a stimulant, it’s it it increases the heart rate and it causes vasoconstriction which are both the reasons for high blood pressure. Beta blockers block the effects of epinephrine or adrenaline from causing that, now some beta blockers work strictly on the heart, others work both on the heart an on the blood vessels. So they slow down the heart rate and reduce blood pressure and they also cause a relaxation of the blood vessels therefore widening them which one of the key points of blood pressure is the narrowing of the blood vessels.
What we have here is the blood vessels relaxing the beta blockers also will slow down the heart rate decreasing the workload on the heart and then decreasing the heart pressure or the blood pressure. Beta blockers are taken by mouth and usually you would take this, if it’s twice a day, once in the morning and usually once in the evening, to make sure that you have full coverage during the day and night.
The common side effects for beta blockers are cold hands and feet which I’ve had people tell me that they have, but it goes away after a period of time, sometimes people are complaining about being tired, sometimes there’s some weight gain. Usually these are transient side effects and are common ones, but again if you have a persistent side effect and it’s to the point where it truly bothers you, you need to contact your health care provider. Maybe they need to change the dosage strength, maybe they need to change the medication, but you should let your provider know.
Now couple of key points with beta blockers, if you have underlying asthma this is a medication which you probably may not want to have prescribed to you, and of course your health care provider would know this. Beta blockers can stimulate an asthmatic attack so it’s important that you make sure that your provider knows that you have asthma, or your pharmacist knows that you have asthma, so that there are two people health care professionals that can intercede if that should be ever prescribed. Also, another important area that beta blockers can cause problems with is with patients with diabetes. Beta blockers can mask a low blood sugar so if you’re on a beta blocker you need to make sure that the physician, if it’s a different physician or different health care provider that is treating you for diabetes , that they know that you’re also on a beta blocker. Usually what occurs if you are on a beta blocker and have diabetes you’ll be probably taking blood sugar readings and measurements a lot more frequently to make sure that you get a true reading and that the beta blocker isn’t masking the possibility of having low blood sugar. Also beta blockers can cause rapid heartbeat in patients who have diabetes.
So if any of this occurs, if you start to find out that your blood sugar is not properly being managed, and you’re on beta blockers, make sure that you indicate that and you contact your health care provider about that immediately.
A key caution with beta blockers is, do not stop them abruptly, so make sure that you’re taking them, make sure that you’re taking them on the approved regimen. Unless your healthcare provider titrates you off the beta blockers make sure you’re constantly taking it and adhering to the regimen that the health care provider prescribe for you.
The next group of medications are called vasodilators, and obviously the name gives it away. What they do is they relax the muscles in your blood vessels and therefore allows
them to widen. Again, I am going back to the previous example or description of high blood pressure. They counteract the narrowing of your blood vessels and therefore reduce the blood pressure that way. With the narrowing of the blood vessels causing a resistance to the fluid in blood going through, these relax the blood vessels allowing the blood and fluid to easily pass through reducing blood pressure. The heart doesn’t have to pump as hard to push the same amount of fluid and blood through in a normal sized blood vessel. So vasodilators work by relaxing the blood vessels muscles, widening them, and because of that the heart doesn’t have to pump is hard. The workload of the heart is reduced, the pressure the blood pressure or the pressure that the heart has to pump fluid in blood through those widened blood vessels is less, and that’s how it works directly on the blood vessels.
These medications are usually taken orally and they can be given once a day twice today. Some of the medications are actually given a sublingually, now what that means is under the tongue. The reason why they’re given under the tongue is for the action. The rapid action of having a medication, and one of the medications or the medication used like that is called nitroglycerin, and it’s put under the tongue and dissolves very quickly. It is absorbed very quickly through the blood vessels in and surrounding the mouth and because of the blood vessels proximity to the heart the action is very quick.
Some of the common side effects of vasodilators are rapid heartbeat, heart palpitations, some headaches, and possibly with one particular type of medication, excessive hair growth. That particular medication is called Minoxidil. There may be some joint pains, some chest pains, again these should be transient, but if they if they persist if they are bothering you or you feel a bit uptight and nervous about it contact your health care provider explain to them the situation. They may change the dosage or medication regimen to reduce any of the side effects. One particular drug interaction that we need to know about, and this is important that your pharmacist knows as well as obviously your health care provider, is if you are taking a erectile dysfunction medication. There could be a serious drug interaction between that medication and the vasodilators so it’s important that your pharmacist knows, especially if you are being seen by a number of different doctors.
The final category that we’re going to be talking about today is Calcium Channel Blockers, and again blockers basically calcium channel blockers prevent calcium from entering into the cells of muscles, and what this does is it reduces the force of contraction of those muscles. So what it does for the heart, and the heart being a muscle, it reduces the force of contraction of the heart therefore reduces the blood pressure.
They also it relax is the muscles within the blood vessels and helps widen those blood vessels. We know that high blood pressure is caused by increase in workload of the heart’s force of contraction and the narrowing of blood vessels. These medications block calcium and work on both areas, both the blood vessels by relaxing them as well as reducing the strength of contraction of the heart, and reducing workload and blood pressure.
There is with this particular group a dietary precaution that you may want to make sure you note, and that is with any grapefruit products. While taking certain calcium channel blockers they can interact and affect the heart rate and blood pressure. Some of these symptoms of that interaction are headaches and dizziness. So while you’re on a calcium channel blocker you want to avoid grapefruit and grapefruit containing juices.
As always all of these notes and there’s a there’s an entire transcript of this episode on my website in the show notes and there for you to download, print, and share. All of the links and information about the medications and names of the medications will also be listed
Examples of beta blockers taken by mouth include:
- Atenolol (Tenormin)
- Bisoprolol (Zebeta)
- Metoprolol (Lopressor, Toprol XL)
- Nadolol (Corgard)
- Nebivolol (Bystolic)
- Propranolol (Inderal, InnoPran XL)
Common side effects of beta blockers can include:
- Cold hands or feet
- Weight gain
Less common side effects include:
- Shortness of breath
- Trouble sleeping
Commonly prescribed include:
- Isosorbide dinitrate (Isordil)
- Isosorbide mononitrate (Imdur)
- Hydralazine (Apresoline)
- Nitroglycerin (Nitro Bid, Nitro Stat)
Side effects for Vasodilators include:
- Rapid heartbeat (tachycardia)
- Heart palpitations
- Fluid retention (edema)
- Excessive hair growth
- Joint pain
- Chest pain
Calcium Channel Blockers
(Also known as Calcium Antagonists or Calcium Blockers)
Commonly prescribed include:
- Amlodipine (Norvasc)
- Diltiazem (Cardizem, Tiazac)
- Felodipine (Plendil)
- Nifedipine (Adalat, Procardia)
- Nimodipine (Nimotop)
- Nisoldipine (Sular)
- Verapamil (Calan, Verelan)
Side effects of calcium channel blockers may include:
- Fast heartbeat (palpitations)
- Swelling in the feet and lower legs
- Types of blood pressure medications. American Heart Association. https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications. Accessed July 14, 2021.
- Argulian E, et al. Misconceptions and facts about beta-blockers. The American Journal of Medicine. 2019; doi:10.1016/j.amjmed.2019.01.039.
- Whelton PK, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13.
- Mann JFE. Choice of drug therapy in primary (essential) hypertension. https://www.uptodate.com/contents/search. Accessed June 28, 2019.
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- Types of blood pressure medications. American Heart Association. https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications. Accessed Sept. 21, 2021.
- 8 Brook RD, et al. Treatment of resistant hypertension. https://www.uptodate.com/contents/search. Accessed Sept. 21, 2021.
- 9 Whelton PK, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018; doi:10.1161/HYP.0000000000000065.
- Mann JFE. Choice of drug therapy in primary (essential) hypertension. https://www.uptodate.com/contents/search. Accessed June 25, 2019.
- Types of blood pressure medications. American Heart Association. https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications. Accessed July 26, 2021.
- Sidawy AN, et al., eds. Atherosclerotic risk factors: Hypertension. In: Rutherford’s Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Accessed July 11, 2019.
- Bakris GL, et al. Calcium channel blockers. In: Hypertension: A Companion to Braunwald’s Heart Disease. 3rd ed. Philadelphia, Pa.: Elsevier Saunders; 2018. https://www.clinicalkey.com. Accessed July 19, 2019.
- Aronson JK, ed. Calcium channel blockers. In: Meyler’s Side Effects of Drugs. 16th ed. Amsterdam, Netherlands: Elsevier; 2016. https://www.clinicalkey.com. Accessed July 19, 2019.
- Block MJ, et al. Major side effects and safety of calcium channel blockers. https://www.uptodate.com/contents/search. Accessed July 19, 2019.
Sept. 16, 2021