Other drugs used to treat high blood pressure include angiotensin-receptor blockers, direct renin inhibitors, vasodilators, and alpha blockers.
Drugs known as angiotensin-receptor blockers (ARBs) block the effects of angiotensin, a hormone that would otherwise cause arteries to constrict. They are similar to ACE inhibitors in their action and ability to both lower blood pressure and protect the kidneys, but may have fewer or less severe side effects, including cough. They may even improve sexual function in men. As with ACE inhibitors, ARBs should be considered the first choice for blood pressure medication when other conditions, such as heart failure, heart disease, and diabetes, are also present. They are also associated with increasing blood potassium and angioedema. They should be used with caution in people with advanced disease.
Direct renin inhibitors
Aliskiren (Tekturna) has been approved for blood pressure control since 2007 as a stand-alone agent or in combination with another medication. This medication inhibits an enzyme called renin. Renin is responsible for the formation of angiotensin II, a potent blood pressure elevating protein. Although generally well tolerated, people who are pregnant, have advanced kidney disease, problems with high potassium, or a known allergic reaction called angioedema, should not take aliskiren. The most common side effect is diarrhea.
Vasodilators, which widen blood vessels, are often used in combination with a diuretic or a beta blocker. They are almost never used by themselves. Representative vasodilators include hydralazine (Apresoline), clonidine (Catapres -- available in tablets or as a skin patch), and minoxidil (Loniten), and nitroglycerin.
Alpha blockers, such as doxazosin (Cardura) and prazosin (Minipress), widen blood vessels, thereby reducing blood pressure. However, a major study on doxazosin was stopped when it was associated with a higher risk of chest pain, stroke, and heart failure compared with a diuretic. At this time, until more is known, they are only recommended for reducing blood pressure if no other agents are effective. They may be considered as an alone ageint in older men who have symptomatically enlarged prostates.
Steven Kang, MD, Division of Cardiac Pacing and Electrophysiology, East Bay Arrhythmia, Cardiovascular Consultants Medical Group, Oakland, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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