The main goal of a hypertensive patient and the physician should be to find a drug or combination of drugs that reduces the blood pressure to a normal level without unbearable side effects. It is a team effort, and both the doctor and the physician, after discussion and clinical examination and evaluation, decide on a regimen which is patient friendly and keeps them fully active with no or few side effects. The important factors considered by a doctor before deciding on a proper drug for treatment of hypertension are:

i) Tolerance of the patient to a drug: If taking a certain medication produces side effects that are unpleasant to live with, such as impotence, headaches or fatigue, then it is probably not the best drug for the person. Medication's side effects sometimes seem far worse than the hypertension itself (which may or may not produce apparent symptoms). Under these circumstances doctor and not the patient decides whether to continue or stop the drug.

ii) Compliance with the prescription: If a certain medication is fairly complicated to take and the patient has a busy schedule, he or she may forget to take it. Since it is vital that the patient takes the medication properly, the medication that the doctor prescribes should fit the patient's lifestyle.

iii) Ability to pay for the medication: Some people do not have insurance or financial resources to pay for their drugs. A drug must be cost effective. A drug doesn't do any good if it cannot be taken correctly as a patient cannot afford it.

iv) Drug interactions: There are many anti-inflammatory drugs which interfere with blood pressure medication. Therefore, a doctor must know about patients drug history before he decides on a proper anti-hypertensive drug. Ignorance of a patient's drug history can lead to dangerous drug interactions.

Anti-hypertensives (The Future)

Even with the wide variety of blood pressure drugs in use now, researchers and drug companies continue to seek new medications that are more effective, cost effective and with fewer side effects. Some new drugs being studied are:

Dual Metalloprotease Inhibitors: These drugs could be even more effective than ACE-inhibitors according to the researchers and can reduce blood pressure in up to 80 percent of people with high blood pressure. They block a substance that narrows arteries and increases another that opens them wider (facilitates vaso dilation and inhibits vasoconstriction).
Endothelium Inhibitors: The drugs prevent a powerful blood vessel constrictor called ET -1 from getting into the muscles in the wall of blood vessels.
Natriuretic Peptide Clearance Inhibitors: These drugs ensure that certain compounds that fight high blood pressure remain in our body.
Renin Inhibitors: These drugs block development of the enzyme renin, needed to produce angiotensin II, a powerful blood vessel constrictor.
Vasopressing Antagonists: This type of drug prevents blood vessel narrowing linked to the retention of sodium. If approved the drug could be particularly useful for people who are sodium sensitive. Research is in full swing in the development of this drug.

Gene Research

In more than 90 percent of people with high blood pressure the specific cause of their condition is unknown. Some of the research being done on high blood pressure involves identifying genes that may trigger the disease. Initial research shows that high blood pressure is a complex illness that does not follow the classic rules of inheritance. Instead of arising from a single defective gene it appears to be a multifaceted disorder that involves interaction between several genes. In addition, environmental factors including weight, sodium use and physical activity also appear to play a role in gene interaction. In future, drugs can be custom made to prevent high blood pressure by controlling specific genes. Rapid progress in genetic research will soon make this possible.

Synopsis

Drugs are needed for treatment of hypertension if lifestyle changes aren't effective.
One drug or a combination of drugs are needed to treat hypertension.
A diuretic or beta blocker is often prescribed for uncomplicated hypertension.
Blood pressure medications have only minimal side effects.
Finding the correct drug or drugs to control blood pressure requires time, patience and a doctor-patient's team work.
Genes and their research may soon find an answer to treat high blood pressure effectively.

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