There is a wide range of antihypertensive medicines available, so a choice is made based on several factors, including how high the BP is, the patients age and their ethnicity. In many cases, more than one drug needs to be taken in order to lower BP. Click on the numbers below to find out about the antihypertensive medicines available.

• Angiotensin-converting-enzyme inhibitor (ACE) inhibitors affect certain hormones that regulate fluid balance in the body and therefore lower BP. These drugs have the suffix -pril, e.g. ramipril.

• Angiotensin receptor blockers (ARBs) work in a similar way to ACE inhibitors. These have the suffix -sartan, e.g. losartan.

• Calcium channel blockers reduce the amount of calcium going into the muscles of the heart and blood vessels, which reduces the strength of cardiac contractions and opens up the circulation. Many of these have the suffix -dipine, e.g. amlodipine, but there are also some older drugs in this class such as diltiazem and verapamil.

• Diuretics, such as bendroflumethiazide, are often referred to as water tablets because they reduce blood pressure by promoting fluid loss from the body.

• Beta-blockers slow heart rate and open up blood vessels. These drugs have the suffix -olol, e.g. atenolol.

• Alpha blockers relax the smooth muscles in the walls of the blood vessels and so cut BP. These have the suffix -zosin, e.g. doxazosin.

• Renin inhibitors bring down BP by affecting the same hormone system as ACE inhibitors and ARBs. These are denoted by the suffix -kiren, e.g. aliskiren.

It is very important with hypertension that the patient is given plenty of information about their treatment, including the risks of side effects and the benefits of keeping their BP under control. This is because the condition is symptomless, so some people find it difficult to take their medication as prescribed. Practical ways in which non-adherence can be addressed include:

• Asking the patient to record when they take their medication
• Simplifying the dosing regimen
• Using packaging that is easy to get into, or has dosing reminders on
• Using a compliance aid that has times of day on it
• Setting up dosage reminders, for example on a mobile phone.

It is also important that patients with hypertension are monitored regularly. This should include assessment of BP, renal function and the risk of experiencing a cardiovascular issue such as a stroke. There should also be an opportunity to discuss lifestyle and any problems that the patient is attributing to the medication they are on, such as side effects.

Some people have higher BP measurements than normal when they are at the GP surgery or another medical setting. This is known as “white coat effect”. If this is suspected, ambulatory or home blood pressure monitoring (ABPM and HBPM) is recommended. With ABPM, two measurements need to be taken per hour during the person’s usual waking hours so an average can be calculated. With HBPM, two measurements should be taken at least a minute apart (with the person sitting down) twice a day (ideally morning and evening) for at least four days, and then all but the first day’s values averaged.