antihypertensive drug

[saveme2010]

my mother-in-law is diagnosed with Diabetes Type 2 and is also recently having hypertension and is taking metoprolol.What is the best antihypertensive medication for her?

[MichelleHBP]

Here is another link:

http://www.webmd.com/hypertension-high-blood-pressure/guide/high-blood-pressure

Diabetes and High Blood Pressure

How Is High Blood Pressure Treated?

ACE (angiotensin converting enzyme) inhibitors are a group of medications that are often used to treat high blood pressure in people with diabetes. Although other high blood pressure medicines are available, ACE inhibitors have been shown to not only to be a useful drug to treat high blood pressure, but it has been shown to prevent or delay the progression of kidney disease in people with diabetes.

Note: Some blood pressure medicines may adversely affect your blood sugar level. Blood pressure medicines can also cause impotence. Talk with your doctor about the side effects of prescribed medicines.

Some blood pressures medications also seem to work better on certain populations of people. Diuretics for example seem to be particularly beneficial in the elderly and may also be beneficial in people with hypertension that is salt sensitive as is frequently seen in African Americans.

Other drugs used to treat high blood pressure in people with diabetes include a class of drugs known commonly as 'water pills' or diuretics.

Because adequate control of blood pressure usually requires more than one medication, most doctors use ACE inhibitors first then add other anti-hypertension drugs.
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And another link (note that it says "Patients with diabetes, especially those with regular episodes of low blood sugar (hypoglycemia)" should use BB's with caution):

http://www.medicalnewstoday.com/articles/173068.php

"What do beta-blockers do?

Beta-blockers block the release of noradrenalin in parts of the body. Noradrenalin is released by the nerves when they are stimulated - it is a chemical that conveys messages to other parts of the body, including muscles, blood vessels and the heart.
Heart problems - for a patient with heart problems beta-blockers can reduce the workload for the heart; so that it does not have to work so hard to supply all parts of the body with oxygen-rich blood. For people with angina, heart failure, or after a heart attack, reducing the heart's workload is crucial.

Beta-blockers can also block the stimulation of the heart form electrical impulses - they can control irregular heartbeats - thus lowering the activity of the heart and slowing down the heart rate.

Hypertension - beta-blockers lower blood pressure by slowing down the heart rate, as well as reducing the force of the heart. Blood still gets to all parts of the body, but at reduced pressure.

Glaucoma - pressure within the eyeball is reduced with beta-blocker eye drops. The medication lowers the production of fluid inside the eye ball (aqueous humor).
Things to bear in mind with beta-blockers

The following people should not take beta-blockers:

Patients with a history of asthma (unless the doctor says so)
Patients with a history of bronchospasm (unless the doctor says so)
Patients with second or third degree heart block
Patients with severe peripheral arterial disease (including Raynaud's syndrome)
Patients with worsening, unstable heart failure (can be used for stable heart failure)

For the following people, beta-blockers should be used with caution:

Patients with diabetes, especially those with regular episodes of low blood sugar (hypoglycemia)
Patients with MG (myasthenia gravis)
Patients with a slow heart rate (bradycardia)
Patients with low blood pressure (hypotension)
Patients with hypertension that results from an adrenal gland tumor (pheochromocytoma)
Patients with high blood acid levels (metabolic acidosis)
Patients with Prinzmetal angina"

[MichelleHBP]

That is a tough question. Her doc needs to take into account a lot of things, as I'm finding out myself in a search for the right HBP meds. I'm not sure my doc is doing that.

I hope that someone here who has experience with both conditions will share their history with these meds.

Do you know why her doc put her on a beta-blocker to start? While beta blockers work for some specific conditions, I think other meds are usually tried first.

Here's an excerpt and link to UK guidelines:

http://www.patient.co.uk/health/Medication-for-High-Blood-Pressure.htm

"So, which is the best drug or combination of drugs?

The one or ones chosen may depend on such things as: if you have other medical problems; your ethnic origin; if you take other medication; possible side-effects; your age; etc.

For example: beta-blockers and calcium channel blockers can also treat angina; ACE inhibitors also treat heart failure; some drugs are not suitable if you are pregnant; some are thought to be better if you have diabetes; some tend to work better than others in people of Afro-Caribbean origin; etc.

If you do not have any other medical problems that warrants a particular drug, then current UK guidelines give the following recommendations as to usual drugs that should be used. These recommendations are based on treatments and combinations of treatments that are likely to give the best control of the blood pressure with the least risk of side effects or problems. Treatment is guided by the A/CD approach as follows:

If you are less than 55 years old and are not of black African or Caribbean origin then initial treatment should be with 'A' (an ACE inhibitor, or an angiotensin receptor blocker if an ACE inhibitor causes problems or side effects).

If you are 55 years or older, or are of black African or Caribbean origin then initial treatment should be with 'C' or 'D' (a calcium-channel blocker or a diuretic).

Then, if the target blood pressure is not reached, combine 'A' with 'C' or 'D' (an ACE inhibitor or an angiotensin receptor blocker plus a calcium-channel blocker or diuretic).
Then, if target blood pressure is still not reached, combine 'A' with 'C' and 'D' (an ACE inhibitor or an angiotensin receptor blocker, and a calcium-channel blocker, and a diuretic).

If a fourth drug is needed to achieve the target blood pressure, consider adding of one of the following:

A beta-blocker
Another diuretic
An alpha-blocker

However, individuals can vary. Sometimes, if one drug does not work so well or causes side-effects, a switch to a different class of drug may work fine."

Try doing a search in PubMed or in Google, adding the search term 'studies'.

Here's a recent study about BB's that could scare my pants off but my mom took Lopressor (a BB) for forty years and they worked well for her:

"Conclusion: BBs have increased risk for CV mortality when compared with RAS blockade therapy in diabetic patients with hypertension. BBs do not have increased risk for myocardial infarction, stroke, CV mortality, and total mortality when compared with control antihypertensive therapy in diabetic patients with hypertension."

http://journals.lww.com/americantherapeutics/Abstract/2009/03000/Comparative_Analysis_of_Beta_Blockers_With_Other.6.aspx

[WaveRider]

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