Are all hypertension medicine the same?

Hypertension (HTN), commonly known as high blood pressure, happens when the pressure in the blood vessels are persistently high (140/90 mmHg and above) for at least twice on two separate occasions.^1,2Once a person is diagnosed with HTN, depending on severity, the doctor will advise for lifestyle changes and may prescribe antihypertensive medicine to bring it down to normal level, ideally 120/80mmHg.

According to the National Health and Morbidity Survey done in 2019, it was found that 3 in 10 Malaysians have HTN and among this group of people, 90% of them are taking antihypertensive medicine.³ There are so many types of antihypertensive medicines available in the market and it can be classified into:^1,4,5,6,7,8

Angiotensin-converting Enzyme inhibitors (ACE inhibitors) Angiotensin is a chemical that narrows the blood vessels in our body, especially the kidneys. ACE inhibitors work by slowing down the angiotensin production by the body, thus helping the blood vessels to relax and open up, ultimately lowering blood pressure. It provides additional kidney protection too. Common side effects are dizziness, dry cough, and increasing the body’s potassium level.

Angiotensin II Receptor Blockers (ARBs) It works by directly inhibiting the angiotensin receptor, thus lowering blood pressure. ARBs have the same benefits and side effects as ACE inhibitors, except for the dry cough side effect. That’s why doctors may consider switching patients responding well to ACE inhibitors to ARBs if they developed the dry cough side effect.

Calcium Channel Blockers (CCBs) It works by preventing calcium from entering the muscle cells of the heart and arteries, thus helping the blood vessels to relax and open up, ultimately reducing heart rate and blood pressure. Common side effects are swollen feet, constipation, drowsiness.

Beta-Blockers It works by blocking the hormone called Adrenaline, which leads to slowing down the heart rate, the heart’s workload and the heart’s output of blood, thus lowering blood pressure. Common side effects are insomnia, constipation, lethargy, dizziness, low heart rate, trigger asthma, and sexual or erectile dysfunction.

Diuretics It works by eliminating excess water and salt from the body, thus lowering blood pressure. Oftentimes, it is used in combination with other antihypertensives. Common side effects are reducing the body’s potassium level, may increase risk of gout, impotence, and may increase blood sugar level in diabetics.

Alpha Blockers It works by blocking a hormone called Noradrenaline that constricts the blood vessels. It additionally relaxes the muscles of the prostate and bladder in men, thus helping to ease urination in men with prostate enlargement. Common side effects are fast heart rate, dizziness, weakness, trembling. Alpha-2 Receptor Agonists It works by reducing activity of the Adrenaline-producing portion of the sympathetic nervous system, thus reducing blood pressure. Some common side effects are drowsiness, dizziness, dry mouth, sexual dysfunction, headache.

Combined alpha and beta-blockers These medicines have both Alpha and beta blockers effect. They are often in IV drops used in a hypertensive crisis when the blood pressure is dangerously high. It is also available in tablet form and is recommended to use for patients at risk of heart failure. Common side effect is that it may cause a drop in blood pressure when the person stands up from a sitting or lying down position.

Now that we know that different antihypertensive medicines have different benefits and side effects, that is all the more reason to never share your prescribed medicine with others even though you both have HTN. That is because the need for medicine may differ from one another. Doctors prescribed medicine based on the patient’s age, family history, allergy history, severity of the disease, existence of other diseases and their risk factors, possible drug interaction with other medicine etc.⁹

All treatments are individualized and personalized, that’s why the best medicine for one may in turn cause harm to others. After all, everyone’s body works differently and responds differently to different medicines.⁹ So if you suspect that you may have HTN, go straight to your doctor immediately for a check up. For those of you who are prescribed antihypertensive medicine, make sure to be compliant to your medicine and take it at the same time everyday to stabilize your blood pressure. Do visit the doctor if you ever experience any problems like uncontrolled blood pressure despite being compliant to your medicine or if you ever experience any undesired side effects of the medicine.

All in all, manage your blood pressure by practicing a good lifestyle such as reducing salt intake, exercising regularly and avoiding alcohol and smoking.^1,2 But most importantly, do a yearly health check with your doctor and regular monitoring at home² or at your neighborhood CARiNG pharmacy.