Controlling Hypertension

Drugs that treat high blood pressure are either short-acting or long-acting. The former won’t control blood pressure throughout the day. To do this, you have to increase the dosage or take it several times a day.

In contrast, long-acting drugs can control your blood pressure much longer much longer or as much as 24 hours. You simply take one tablet at the prescribed time each day and get on with your life.

At first, doctors thought it didn't matter whether you took one or the other. After all, both of these drugs lowered blood so what more could a physician ask?

However, recent studies show that not all antihypertensives can protect you from the complications of hypertension even if they lower blood pressure. While short-acting agents can make your blood pressure drop, the effects of these drugs vary greatly throughout the day – like a Ping-Pong ball bouncing up and down. Obviously, that's to be expected when you're playing Ping-Pong – but not when you’re treating hypertension.

These concerns were aired during the 16th Scientific Meeting of the International Society of Hypertension (ISH) in Glasgow in the United Kingdom. Dr. John P. Chalmers, ISH president, said the “Ping-Pong effect could lead to a rapid fall in blood pressure (hypotension), tachycardia (rapid heart beat), and other cardiac problems.

The same view is shared by Dr. Henry L. Elliot of the Department of Medicine and Therapeutics at the Gardiner Institute in Glasgow who said that short-acting drugs don’t seem to offer any protection against overnight hypertension and the subsequent rise in cardiovascular risk during the waking and early working part of the day.

This is bad news for people with hypertension since those with greater blood pressure (BP) variability appear to be at higher risk for end organ damage, according to Dr. Gianfranco Parati, associate professor of cardiology at the University of Milan in Italy. Parati said that the more your BP varies throughout the day, the greater your chances of suffering from cardiovascular complications.

To avoid this problem, the U.S. Food and Drug Administration (FDA) said that drugs used to treat hypertension should not only lower BP but, more importantly, prevent fluctuations in BP which appear to be related to cardiovascular complications.

Because of their limited affects, short-acting drugs don't meet these criteria. The FDA also warned against the use of high doses of short-acting antihypertensives to maintain smooth blood pressure levels for 24 hours since this could counteract the benefits of lower pressure.

Experts say the ideal antihypertensive should be long-acting with a continuous therapeutic affect that can be given once a day yet control BP for 24 hours before the next dose is taken. This will ensure that your BP levels remain stable throughout the day.

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