Blood pressure medication long term side effects
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Long-Term Side Effects of Blood Pressure Medication
Introduction to Blood Pressure Medication
Blood pressure medications, also known as antihypertensives, are essential for managing hypertension and preventing cardiovascular diseases. However, their long-term use can lead to various side effects, which can impact patient compliance and overall health outcomes. This article synthesizes research findings on the long-term side effects of different classes of blood pressure medications.
Long-Term Blood Pressure Control and Side Effects
Efficacy and Attenuation Over Time
Antihypertensive drugs are effective in lowering blood pressure, with the maximal effect observed after 12 months of treatment. However, this effect gradually attenuates over the years, necessitating adjustments in treatment strategies to maintain optimal blood pressure control.
Combination Therapies and Metabolic Effects
Combination therapies, particularly those involving renin-angiotensin system (RAS) modulators, calcium channel blockers (CCBs), and thiazide diuretics, have shown better long-term control of diastolic blood pressure and a more favorable impact on lipid profiles compared to other combinations. For instance, the combination of Perindopril, Amlodipine, and Indapamide was associated with stable blood pressure control and did not lead to an age-related increase in cholesterol levels or the development of type 2 diabetes over an 8-year period.
Specific Drug Classes and Their Long-Term Side Effects
Beta-Blockers and Diuretics
Beta-blockers and thiazide diuretics are commonly used antihypertensives. Long-term use of these medications has been associated with a low incidence of adverse effects necessitating drug withdrawal, approximately 3% per year. However, patients with higher initial blood pressures and more severe hypertension-related complications may require more aggressive treatment and experience more side effects.
Weight-Reducing Drugs
Weight-reducing drugs like orlistat and phentermine/topiramate have been shown to reduce both body weight and blood pressure in hypertensive patients. However, these drugs come with their own set of side effects. Orlistat is associated with gastrointestinal issues, while phentermine/topiramate can cause dry mouth and paresthesia. Sibutramine, another weight-reducing drug, was found to increase diastolic blood pressure and has been withdrawn from the market due to severe side effects .
Antidepressants and Blood Pressure
Certain antidepressants can influence blood pressure. Selective serotonin reuptake inhibitors (SSRIs) are generally safe with minimal impact on blood pressure. In contrast, serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine can increase blood pressure, particularly at higher doses. Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) can also cause significant blood pressure changes, including hypertensive crises .
Persistence and Compliance
Medication Persistence
Persistence with antihypertensive treatment is crucial for effective long-term blood pressure control. Angiotensin II receptor blockers (ARBs) have shown higher persistence rates compared to other drug classes, which translates to better long-term outcomes despite their higher cost per tablet. This makes ARBs a cost-effective option when considering the overall healthcare costs associated with poor blood pressure control.
Conclusion
Long-term use of blood pressure medications is essential for managing hypertension but comes with various side effects that can impact patient compliance and health outcomes. Combination therapies involving RAS modulators, CCBs, and thiazides appear to offer better long-term control and metabolic profiles. Weight-reducing drugs and certain antidepressants can also affect blood pressure, necessitating careful monitoring. Persistence with treatment, particularly with ARBs, is crucial for achieving sustained blood pressure control and reducing overall healthcare costs.
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