High blood pressure is the "silent killer": it does not hurt, but it raises the risk of heart attack, stroke and kidney disease. The good news is that we have very effective drug classes that are, for the most part, reimbursed. Here is how antihypertensives are chosen — for information only, because the correct regimen is always set by the doctor, based on your profile.
The four to five basic classes
Angiotensin-converting enzyme inhibitors (ACE inhibitors) — enalapril, ramipril, perindopril — relax the blood vessels and protect the kidney, especially in people with diabetes. The classic side effect is a dry cough; rarely, angioedema.
ARBs (angiotensin receptor blockers) — valsartan, telmisartan, candesartan, losartan — have benefits similar to ACE inhibitors, but without the cough; they are the natural alternative for those who do not tolerate ACE inhibitors. ACE inhibitors and ARBs are not combined with each other.
Calcium channel blockers — amlodipine, the most widely used — dilate the arteries; they can cause ankle swelling.
Diuretics — indapamide, hydrochlorothiazide — remove excess salt and water; thiazides are among the first-line options.
Beta-blockers — metoprolol, bisoprolol, nebivolol — lower the heart rate and are particularly useful after a heart attack or in heart failure.
Why, often, several pills
Real hypertension is frequently controlled with low-dose combinations (for example an ACE inhibitor or ARB + amlodipine + a diuretic), rather than with a single substance at a high dose — the effects complement each other, while the side effects stay small. Many combinations exist in a single tablet, which makes adherence easier. The European ESC/ESH guidelines form the basis of these regimens.
Monitoring and caution
With ACE inhibitors, ARBs and diuretics, the doctor periodically checks potassium and creatinine (kidney function). Do not stop a beta-blocker abruptly. Anti-inflammatory drugs (NSAIDs) taken frequently can reduce the effect of antihypertensives and can harm the kidney — one more reason not to treat yourself "by guesswork". Almost all commonly used antihypertensives are reimbursed by CNAS, with a prescription from the family doctor or cardiologist.
What depends on you
Cutting down on salt, exercise, weight, sleep and measuring your blood pressure correctly at home matter just as much as the pill. Keep a log of your readings and bring it to your check-up. For up-to-date prices of antihypertensives at nearby pharmacies, use the HartaFarmacii search.
- ESC/ESH — the European guidelines for the management of arterial hypertension
- ANMDMR — SmPC for ACE inhibitors, ARBs, calcium channel blockers, diuretics, beta-blockers
- WHO — hypertension as a cardiovascular risk factor
- CNAS / CANAMED — reimbursement