Blood Pressure Drugs

Special Considerations for Women with Diabetes

It is especially important for women with diabetes to control their blood pressure. Studies have determined that maintaining blood pressure at 130/80 or below dramatically reduces the risk of heart attack, stroke and death in people with diabetes. Two types of antihypertensives, diuretics and angiotensin-converting enzyme inhibitors, are usually the most effective in people with diabetes, and it may take a combination of two or more of those drugs to bring blood pressure down to target levels.

Racial Differences in Blood Pressure

Blood pressure not only tends to be higher among African American women, high blood pressure also begins at an earlier age and is often more serious. African American women are more likely to have a stroke, heart disease or kidney failure as a result of their high blood pressure than Caucasian women are.

How Antihypertensive Drugs Work

Blood pressure can be lowered either by reducing the volume of blood in the vessel, or by relaxing vessel walls to increase the diameter of blood vessels. There are a growing number and type of drugs that produce these effects. Because they work in a number of ways—from cutting off the production of certain hormones to blocking nerve signals to eliminating fluid from the body—their effectiveness, and the side effects they produce, vary extensively.

Types of Antihypertensives

Although all antihypertensive medications are aimed at the same goal—to bring blood pressure down—they go about it in different ways and affect each woman differently. If you’re taking an antihypertensive, your reaction to the drug is as important as the drug’s effect on your blood pressure. If your medication has unpleasant side effects, tell your doctor.

The following are the basic types, or classes, of blood pressure drugs.

• Diuretics are sometimes called “water pills” because they work in the kidney and flush excess water and sodium from the body. Because they are inexpensive and have been found to be safe over generations of use, they are often prescribed first, especially for African American women. Taking a diuretic may mean more trips to the bathroom, but it can also reduce puffiness and swelling. Many diuretics also lower the body’s levels of potassium, which is essential to muscle function, so you may have to eat more potassium-rich foods like bananas and oranges or take a potassium supplement.
• Beta-blockers reduce nerve impulses to the heart and blood vessels. This makes the heart beat slower and with less force. Blood pressure drops, and the heart works less hard. Beta-blockers have the unusual side effect of reducing anxiety, and have become popular with actors and musicians as a means of reducing stage fright. They can also make it difficult to exercise vigorously and may increase the risk of developing Type 2 diabetes.
• Angiotensin-converting enzyme (ACE) inhibitors prevent the production of angiotensin II, a hormone that causes blood vessels to narrow. Because ACE inhibitors keep the vessels relaxed, blood pressure goes down. Because ACE inhibitors have been linked with birth defects, they shouldn’t be taken by pregnant women. Instead, they are usually reserved for patients whose blood pressure isn’t controlled by diuretics or beta-blockers or who have heart failure or diabetes.
• Angiotensin antagonists shield blood vessels from angiotensin II and have the same effects as ACE inhibitors. Like ACE inhibitors, they are linked to birth defects, so shouldn’t be taken by women who are pregnant.
• Calcium channel blockers (CCBs) keep calcium from entering the muscle cells of the heart and vessel walls to relax blood vessels and reduce the pressure in them. CCBs aren’t first-choice drugs for lowering blood pressure in women. A report from the Women’s Health Initiative indicated that the cardiac death rate was significantly higher in women taking CCBs, either alone or with a diuretic, than in women taking other blood pressure drugs.
• Alpha-blockers dampen a different set of nerve impulses to blood vessels than beta-blockers do. However, the effects are similar: vessel walls relax, allowing blood to pass more easily through the vessels, reducing blood pressure. Alpha-blockers also relax the smooth muscles of the bladder, increasing the risk of incontinence, especially in older women.
• Alpha-beta-blockers have the therapeutic effects, as well as the side effects, of both alpha- and beta-blockers. As a result, less blood is pumped through the vessels, and the blood pressure goes down.
• Vasodilators relax the muscle in the heart and vessel walls, causing the blood pressure to fall. They can cause faintness and flushing in some women. They are not recommended for women who are pregnant or nursing.