The drug used to control hypertension depends on a number of factors including:

• Age
• Ethnic origin
• Other medical problems
• Other medication
• Side effects

Ethnic background has been found to effect which drug is most effective in controlling hypertension. ACE inhibitors tend to work best in white people, with calcium channel blockers or thiazide diuretics being more effective for people of Afro-Caribbean origin.

Primary hypertension is treated with drugs that reduce blood volume, decrease systemic vascular resistance and lower cardiac output. Secondary hypertension is treated by controlling the underlying disease causing the hypertension.

A doctor may change medication or suggest a ‘dual approach’ combining the existing drug with another that produces slightly different effects. A combination of up to 3 different drugs may be used e.g. beta blockers are often used in conjunction with a diuretic.

In most cases, antihypertensives are taken for life. However if blood pressure has been controlled for 3 or more years, or is falling too low, blood pressure medication may be stopped.

Side effects of taking medication to control hypertension tend to decrease the longer the drug is taken as the body gets used to having it in its system. If side effects persist, then stopping taking the medication should cause them to diminish within a few days.

In many cases one drug is not sufficient to decrease high blood pressure to the target level and so it is more common to need 2 or more different drugs to reduce high blood pressure to the desired level.

The dual approach may also refer to combining anti-hypertensive medication with lifestyle changes e.g. diet and exercise with the aim of controlling hypertension.

Normal blood pressure ranges between 90/60mmHg and 140/90mmHg and so drugs used to control hypertension aim to get blood pressure within this range. For some blood pressure needs to be even lower e.g. with diabetics, or patients with chronic kidney disease.