Once you have been diagnosed with hypertension, treatment will be recommended by your doctor depending on your blood pressure reading and your risk of developing complications.
MEDICINE FOR HIGH BLOOD PRESSURE
There are several types of medications that can be used to control your blood pressure. You might need to take a combination of medication. There are some factors that will determine the type of drug your doctor will prescribe. For example, your age and race will be deciding factors.
Blood pressure medication may need to be taken for the rest of your life, so its good to understand this from the get-go. Only your doctor should adjust your medication.
It is also very important to take your medication as instructed by your doctor. If you miss a dose, the medication will not work as well as it should. Hypertension medication might not make you feel different; however, this does not mean it is not working.
If you have problems taking the medication or are experiencing side effects, please don’t stop taking the medication. Contact you doctor in order to discuss alternative options.
In order to encourage adherence, basic knowledge of the medication is needed. Below are some of the common medication used to treat hypertension and a brief explanation of how it works.
ACE inhibitors, stands for Angiotensin-converting enzyme inhibitors, this medication works by relaxing the blood vessels. Common examples of ACE inhibitors are enalapril, lisinopril and ramipril.
ARBs, stands for Angiotension-2 receptor blocker. These work in a similar way to ACE inhibitors. This class of medication is often prescribed if a patient is experiencing side effects with ACE inhibitors. Examples of ARBs are candesartan, losartan and valsartan.
CALCIUM CHANNEL BLOCKERS
Calcium channel blocker (CCB) reduce blood pressure by widening your blood vessels. Some examples of calcium channel blockers are amlodipine and nifedipine.
Diuretics are known as the “water pills’, this is because they work on flushing excess water and salt from the body thereby decreasing blood pressure. Common examples are indapamide and bendroflumethiazide.
Beta blockers reduce blood pressure by causing your heart to beat with less force. Examples of beta blockers are atenolol and bisoprolol.
Medication works best in combination with lifestyle changes. Speak to your doctor or care coach if you need help with implementing these. With good adherence, high blood pressure can be well-controlled and you can live a healthy life.
Written by Dr Ruusa Shivute | Health Window
Reference: Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens 2020; 38:982.
HEART ATTACK & STROKE
WHAT IS BLOOD PRESSURE?
Heart attacks and strokes are among the common diseases of the heart and blood vessels, collectively termed cardiovascular disease (CVD). In South Africa, nearly 200 people die each day from CVD,representing one out of five daily deaths due to HIV/AIDS.  For every woman that dies of a heart attack, two men die. The United Nations predicts that the proportion of the South African population above 60 years will more than becoming the number one cause of death and disease in people over 50 years of age. CVD is common among younger people too, with deaths projected to increase by over 40% in the 35- to 64-year age group by 2030. 
How to prevent a heart attack or stroke?
Your risk of a heart attack increases by three-fold with each risk factor. For example, if you have three risk factors your risk increases 3x3x3 or 27 fold. Three out of every four heart attacks or strokes occur in people who have already suffered such an event, so it is essential to change your lifestyle as early as possible and to do all you can to prevent potentially fatal CVD.1 It’s never too late to make healthy lifestyle changes. [1, 3, 4]
RECOMMENDED LIFESTYLE CHANGES:
Quit smoking and avoid second-hand smoke
Get regular medical check-ups to check for high blood pressure, blood cholesterol and diabetes.
Maintain a healthy weight – excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes.
Exercise regularly for a minimum of 30 minutes a day, five times a week.
Eat a healthy diet – talk to your doctor or nutritionist about eating a heart-healthy diet with plenty of fruit and vegetables and limited saturated fats, cholesterol and salt.
Manage diabetes with regular exercise, eat well, lose weight and take required medication to protect high blood sugar from damaging your blood vessels.
Control stress by managing stressful events and rethinking work habits.
Drink alcohol in moderation – cut down to one drink a day, which may help to increase the ‘good’ (HDL) cholesterol.
If you have obstructive sleep apnea (a sleep disorder in which the oxygen level intermittently drops during the night) get treatment.
WHAT IS A HEART ATTACK AND WHAT ARE THE SYMPTOMS?
It is crucial to promptly recognize symptoms and immediately call for emergency medical help if you think you or someone else might be having a heart attack.
A heart attack, or myocardial infarction, occurs when there is a sudden blockage, usually caused by a clot, in a coronary artery. A coronary artery is a blood vessel that feeds blood to a part of the heart muscle. The interrupted blood flow can cut off blood supply to the heart muscle. If this ‘ischemia’ of the heart happens for more than a few minutes, it can damage or destroy a part of the heart muscle.
COMMON HEART ATTACK SYMPTOMS 
Pressure, tightness, pain or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back
Feeling of fullness, nausea, indigestion, heartburn or abdominal pain
Shortness of breath
Sweating or cold sweat
Feeling anxious or an impending sense of doom
Lightheadedness or dizziness
DID YOU KNOW…
Symptoms vary widely and occur at different levels of severity – some people have no symptoms at all.
The more signs and symptoms you have, the greater the likelihood that you may be having a heart attack.
A heart attack can occur anytime – when you’re resting or moving.
Many people who experience a heart attack have warning signs and symptoms hours to weeks in advance – the earliest warning of a heart attack may be recurrent chest pain (angina) triggered by exertion, and relieved by rest, and caused by a temporary decrease in blood flow to the heart.
WHAT IS A STROKE AND WHAT ARE THE SIGNS AND SYMPTOMS?
A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. Within minutes, brain cells begin to die. A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimise brain damage and potential complications. The good news is that strokes can be treated and prevented.
THE 5 SIGNS OF A STROKE 
1. Trouble walking
2. Trouble speaking and understanding
3. Paralysis or numbness of the face, arm or leg
4. Trouble seeing with one or both eyes
5. Sudden, severe headache
IN THE EVENT OF A POSSIBLE STROKE
Think fast and do the following:
Face – ask the person to smile to see if one side of the face droops
Arms – ask the person to raise both arms to see if one arm drifts downwards
Speech – ask the person to repeat a simple phrase to see if their speech is slurred or strange
Timing – if you observe any of the above signs, call for emergency medical help immediately and don’t wait to see if the symptoms go away.
HOW IS A STROKE CAUSED?
A stroke is most often caused by a severely narrowed or blocked artery (ischemic stroke), which supplies blood to the brain. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up in the arteries and cause reduced blood flow (atherosclerosis) or other artery conditions. A haemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. It may result from uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms).
Aspirin can save lives 
If you’ve had a heart attack or stroke, your doctor may recommend medications to help reduce your risk of having another.[3, 4]
Medications could include anti-platelet drugs:
Platelets are cells in your blood that initiate clots. Anti-platelet drugs make these cells less sticky and less likely to clot. The most commonly used anti-platelet medication is aspirin.4 Doctors recommend an aspirin dose between 81 and 325 mg daily for people who’ve had a heart attack, unless they have had an allergic reaction to aspirin, or have some other serious reason not to take it.
To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. Aspirin is an immediate treatment given in the emergency room to prevent blood clots from forming to reduce the likelihood of having another stroke.
Your doctor can help you determine the right dose of aspirin for you.  Doctors may also prescribe aspirin in combination with an anti-clotting drug, such as clopidogrel, (for people undergoing an angioplasty or stent procedure to open narrowed coronary arteries), before and after the procedure.3 Your doctor may also consider prescribing a combination of low-dose aspirin and the anti-platelet drug dipyridamole to reduce the risk of blood clotting.
1. Steyn K. Heart Disease in South Africa Media Data Document. The Heart And Stroke Foundation South Africa. 2007 July. 2. Maredza M, Hofman KJ, Tollman SM. A hidden menace: Cardiovascular disease in South Africa and the costs of an inadequate response policy response. SA Heart. 2011;8:48-57. 3. Mayo Clinic Staff. Diseases and Conditions. Heart Attack [Internet]. Mayo Foundation for Medical Education and Research; c1998-2014 [2014 May 20; cited 2014 Jun 19]. Available from: http://www.mayoclinic.org/diseases-conditions/heart-attack/basics/definition 4. Mayo Clinic Staff. Diseases and Conditions. Stroke [Internet]. Mayo Foundation for Medical Education and Research; c1998-2014 [2014 Apr 15; cited 2014 Jun 20]. Available from: http://www.mayoclinic.org/diseases-conditions/stroke/basics/definition/con 5. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schünemann HJ, for the American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive Summary. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2)(Suppl):7S-47S
Hypertension Medication Supplements
OVERCOMING SIDE EFFECTS OF HIGH BLOOD PRESSURE MEDICATION
High blood pressure (hypertension) is a serious chronic disease that increases the risk for heart disease and stroke. A class of medication, known as an ACE inhibitor, is used in the treatment of high blood pressure. [1, 4, 6]
Essential nutrients may however be depleted as a result of high blood pressure and the treatment thereof by means of ACE inhibitors. [1, 5]
ACEI-GAP provides a solution for supplementing these essential nutrients, with just one capsule per day. 
Vitamin D and Zinc are two very important role players in cardiovascular health, and both these two essential nutrients are at risk for depletion though high blood pressure and the treatment thereof. [2, 3, 5]
Zinc is essential for the functioning of numerous enzymes, including those involved in keeping the cardiovascular system in good health. [3, 7]
Over and above bone and calcium metabolism, vitamin D (particularly vitamin D3) is recognised as important for cardiovascular health and its deficiency as a potential risk factor for several cardiovascular disease processes. [2, 7]
ACEI-GAP contains vitamin D3 and Zinc that should be taken by each patient suffering from high blood pressure and taking medication for it. [1, 2, 3]
A serious chronic disease with a 67 % increase between 1990 and 20101*
Almost 8 in 10 South Africans ≥ 50 years of age have hypertension, considered the highest incidence ever reported by a nationally representative survey3*
cause of natural death in South Africans ≥ 65 years after diabetes (#1) and cerebrovascular disease (#2)
IMPACT OF ACEIS
Impact of ACEIs on vitamin D & zinc status
13% of deaths overall are caused by high blood pressure
40% of deaths in people with diabetes is caused by high blood pressure
50% of heart disease, stroke and heart failure is caused by high blood pressure
Mortality reduction should be the ultimate goal of antihypertensive treatment 
Role of vitamin D and zinc in RAS & normal BP control
Renin Angiotensin System (RAS)
Dosage & directions for use
Take one (1) capsule daily 
ACEI-GAP. Each capsule contains Vitamin D3 800 IU; Zinc 15 mg. For full prescribing information refer to the package insert. 201809121097800
Health Supplement. This unregistered medicine has not been evaluated by the SAHPRA for its quality, safety or intended use.
Adcock Ingram Limited. Reg. No. 1949/034385/06. Private Bag X69, Bryanston, 2021, South Africa. Tel. +27 11 635 0000 www.adcock.com
Introduction references: ACEI-GAP approved package insert, 2017, Adcock Ingram Reddy Vanga, Role of Vitamin D in cardiovascular health, Americal Journal of Cardiology, Sep 15, 2010, 106(6):798-80 Little PJ, Zinc and cardiovascular disease, Nutrition Journal, Nov, 2010 GUMS JG, Use of ACE inhibitors in the treatment of cardiovascular disease, American Pharmacy Journal, 1992 Jun; (6):62-70 Genevie Kocourek, Nutrient depletion from medications: What should you know?, Trinity Intergrative Family Medicine, June 11, 2016 Richard E. Klabunde, PhD, Angiotensin Converting Enzyme (ACE) Inhibitors, Cardiovascular Pharmacology Concepts, Nov 17, 2017 Amy Myszko, What Are the Benefits of Vitamin D3, Magnesium & Zinc?, Livestrong, Aug 14, 2017 Further references: 1. Hypertension in Sub-Saharan Africa. Why prevention and control are important. A fact sheet from the World Hypertension League and the International Society of Hypertension. [cited 2017 Mar 17]; Available from: http://www.worldhypertensionleague.org/images/HTN_Infographic_Professionals_2015.pdf. 2. ACEI-GAP approved package insert, 2017. 3. Lloyd-Sherlock P, Beard J, Minicuci N, et al. Hypertension among older adults in low and middle-income countries: prevalence, awareness and control. Int J Epidemiol 2014;43:116-128. 4. Lehohla PJ. Mortality and causes of death in South Africa, 2015: findings from death notification. STATS SA statistical release P0309.3. [cited 2017 March 17]; Available from: http://www.statssa.gov.za/?page_id=1854&PPN=P0309.3&SCH=6987. 5. Ferrari R, Boersma E. The impact of ACE inhibition on all-cause and cardiovascular mortality in contemporary hypertension trials: a review. Expert Rev Cardiovasc Ther 2013;11(6):705–717. 6. Seedat YK, Rayner BL, Veriava Y. South African hypertension practice guideline 2014. Cardiovasc J Afr 2014;25(6):288-294. 7. Chun Li Y, Qiao G, Uskokovic M, et al. Vitamin D: a negative endocrine regulator of the renin-angiotensin system and blood pressure. J Steroid Biochem Molec Biol 2004;89-90:387-392. 8. Cohen N, Golik A. Zinc balance and medications commonly used in the management of heart failure. Heart Fail Rev 2006;11:19-24. 9. Sohl E, van Schoor NM, de Jongh RT, et al. The impact of medication on vitamin D status in older individuals. Eur J Endocrinol 2012;166:477-485. 10. Ferder M, Inserra F, Manucha W. The world pandemic of vitamin D deficiency could possibly be explained by cellular inflammatory response activity induced by the renin-angiotensin system. Am J Physiol Cell Physiol 2013;304:C1027-C1039. 11. Mchiza ZJ, Steyn NP, Hill J, et al. A review of dietary surveys in the adult South African population from 2000 to 2015. Nutrients 2015;7:8227-825. 12. Braun LA, Rosenfeld F. Pharmaco-nutrient interactions – a systemic review of zinc and antihypertensive therapy. Int J Cain Pract 2013;67(8):717-725. 13. Golik A, Zaidenstein R, Dishi V et al. Effects of captopril and enalapril on zinc metabolism in hypertensive patients. J Am Coll Nutri 1998;17(1):75-78. 14. Ross CA, Taylor CL, Yaktine AL, et al (eds). Dietary Reference Intakes (DRIs): Dietary reference intakes for calcium and vitamin D. Institute of Medicine, National Academy of Sciences, 2011. [cited 2017 Mar 17]; Available from:from: https://www.nap.edu/13050. 15. Zinc – health professional fact sheet. NIH Office of Dietary Supplements, 2016. [cited 2017 Mar 17]; Available from: https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/