Sun Sentinel Palm Beach Edition
Factors influence which med is best
Dear Dr. Roach: With all the different medications available for high blood pressure, what factors determine the medicine a doctor will prescribe? — J.E.P.
The first consideration is whether the person has any other medical conditions that would make a particular medication more advantageous. Someone with diabetes and protein in the urine would benefit greatly from an ACE inhibitor; a person with blockages in the arteries to the heart should be on a beta blocker; someone with migraines might benefit from a calcium channel blocker or beta blocker.
Similarly, if there is a condition that would make a particular antihypertensive inappropriate, the clinician avoids prescribing it.
If there is no particular reason to pick a class of drug based on other medical conditions, the most commonly used classes of blood pressure drugs are diuretics, calcium channel blockers and ACE inhibitors.
Dear Dr. Roach: I am grateful for your recent explanation of statins and beta blockers. Could you also explain what calcium channel blockers do and how they work? — A.B.
Calcium channel blockers have everything to do with the mineral calcium. Calcium is used as a messenger in the body to turn on and off important cellular functions.
In the heart, blocking calcium channels slows the heart rate and decreases the strength of the heart’s contractions. These drugs are useful for people with high blood pressure.
Blocking calcium channels in the blood vessels opens them up. Amlodipine, nifedipine and many other calcium blockers ending in “-pine” work this way and are useful for blood pressure control.
Dietary calcium has very little or no effect on the action of calcium channel blockers. People on calcium channel blockers have the same dietary calcium needs as anyone else.