High Blood Pressure: Natural Self-help for Hypertension, including 60 recipes. Michelle Berriedale-Johnson

rapid fall in blood pressure after the first dose so treatment should be started with caution – usually at night so that if low blood pressure does occur, this is after you have retired to bed.

      If taking Indoramin, you should avoid alcohol as it boosts alcohol absorption.

      Calcium Channel Blockers

      Calcium channel blockers (e.g. diltiazem, felodipine, isradipine, lacidipine, nicardipine, nifedipine) work by:

       blocking the transport of calcium ions through cell membranes

       relaxing muscles in arterial walls and reducing arterial spasm

       dilating peripheral veins to encourage pooling of blood

      dilating peripheral veins to encourage pooling of blood

       reducing the force of contraction of the heart.

      Treatment must not be stopped suddenly, but should be tailed off slowly to prevent rebound angina. Verapamil is slightly different from the others in the way it works, and should not be used together with a beta-blocker.

      ACE Inhibitors

      ACE inhibitor drugs are so-named because they block formation of Angiotensin Converting Enzyme (ACE). This in turn prevents formation of a substance called angiotensin II – a powerful constrictor of blood vessels – leading to dilation of both small arteries and veins. This reduces total peripheral resistance and arterial blood pressure. ACE inhibitors also increase blood flow to the kidneys, so more fluid and sodium is lost as urine. They are usually considered for treating hypertension when thiazides diuretics or beta-blockers are contraindicated, not tolerated, or fail to control high blood pressure.

      They can cause a sudden fall in BP on giving the first dose, especially in people who are taking diuretics or who are dehydrated. Where possible, diuretic treatment is therefore usually stopped a few days before ACE inhibitor treatment is started. For some, the first dose is best taken at night on retiring to bed. Kidney function and salt balance should be checked before treatment is started. ACE inhibitors may be less effective in people of Afro-Caribbean descent unless combined with a thiazide diuretic.

      Angiotensin-II Receptor Antagonists

      These drugs (e.g. losartan, valsartan, candesartan) are similar to the ACE inhibitors except that instead of inhibiting angiotensin-converting enzyme, they block angiotensin-II to produce similar effects. This dilates blood vessels, stimulates kidney function and may also have a direct action on the brain to reduce drinking and increase urine output. At present, they are mainly used in people who develop a persistent dry cough as a troublesome side-effect of the ACE inhibitors as these particular drugs do not produce this problem.

      Other Drugs

      Occasionally, drugs from the above groups may not be sufficient or suitable for treating an individual case of high blood pressure. Two other drugs are sometimes used: hydralazine or methyldopa.

      Hydralazine is a vasodilator that lowers blood pressure by relaxing arteries and increasing their diameter. When used to treat hypertension, it is usually combined with a beta-blocker and thiazide diuretic to stop the heart rate and cardiac output from increasing and to avoid fluid retention. It may cause a very rapid drop in blood pressure.

      Methyldopa used to be the most popular drug for treating high blood pressure, and may still be taken by elderly patients who started on it many years ago. It lowers blood pressure by acting on the brain to trigger nerve actions that reduce heart output, urine production and arteriolar constriction. Methyldopa is often used together with a diuretic. It may cause a rapid fall in blood pressure, especially in the elderly.

      Your doctor may also suggest taking low-dose aspirin or taking drugs to lower blood cholesterol levels if necessary.

      IS ANTI-HYPERTENSIVE TREATMENT FOR LIFE?

      Once drug treatment is started for high blood pressure, it is often for life. However, if you don’t have any complications from your high blood pressure and you have managed to make diet and lifestyle changes that naturally bring your blood pressure down, it may be possible to reduce your tablet dose or to withdraw it altogether. However, you should never alter your medication or stop it suddenly yourself. If your doctor decides to withdraw your treatment, this is usually done slowly in a step-wise fashion to prevent a sudden rebound hypertension. You will be followed up closely over a long period of time, as, in some cases, BP starts to creep back up again after six months, a year or more.

      IF YOU SHOULD FORGET TO TAKE YOUR MEDICATION

      If you do forget to take your treatment occasionally, it is unlikely that you will come to any harm. If you forget your tablets on a regular basis, however, you may run into problems.

       If your treatment is only a few hours late, take it as soon as you remember.

       If you have missed one dose and your next one is already due, just take one dose – DON’T take an extra dose next time. Be especially careful not to miss any further doses.

       If you forget to take your blood blood-pressure treatment for more than one or two days, contact your doctor for further advice.

      Tips to Help You Remember to Take Your Medication

       Try to take your blood-pressure treatment regularly, at the same time every day, so you get into a routine.

       Write a note for yourself and stick it where you will easily see it.

       Keep your tablets/capsules where you can remember them easily, such as with your toothpaste (but make sure they are out of the reach of children).

       Keep your tablets in a special dispenser box marked with separate containers for different times of the day.

       If you have a programmable alarm watch, set it for when your medicine is due.

       If you live with someone else, ask them to help you remember.

       Make sure you get your next prescription in plenty of time so you don’t run out.

       If you are going away, take enough tablets with you to last the whole time.

      DRUGS TO LOWER HIGH BLOOD CHOLESTEROL

      The best way to reduce high cholesterol is through making dietary changes and increasing the amount of exercise