Treatment

Treatment for secondary hypertension involves treating the underlying medical condition with medications or surgery. Once the underlying condition is treated, your blood pressure might decrease or return to normal.

You may need to continue to take blood pressure medication as well, and any underlying medical condition you have may affect your doctor's choice of medication.

Possible drug choices include:

• Thiazide diuretics. Diuretics, sometimes called water pills, are medications that help your kidneys eliminate sodium and water. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications.

  Diuretics are often generic and tend to be less expensive than other high blood pressure medications. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. Possible side effects of diuretics include weakness, leg cramps and a higher risk of sexual dysfunction.

• Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in Black people — but they're effective when combined with a thiazide diuretic.

  Possible side effects include fatigue, sleep problems, a slowed heart rate, and cold hands and feet. In addition, beta blockers generally aren't prescribed for people with asthma, as they can increase muscle spasms in the lungs.

• Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure.

  Like beta blockers, ACE inhibitors don't work as well in Black people when prescribed alone, but they're effective when combined with a thiazide diuretic. Possible side effects include dizziness and coughing. ACE inhibitors should not be taken during pregnancy.

• Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels. Like ACE inhibitors, angiotensin II receptor blockers often are useful for people with coronary artery disease, heart failure or kidney failure.

  These medications have fewer potential side effects than do ACE inhibitors. Angiotensin II receptor blockers should not be used during pregnancy.

• Calcium channel blockers. These medications help relax the muscles of your blood vessels or slow your heart rate. Calcium channel blockers may work better for some people than ACE inhibitors or beta blockers alone. Possible side effects include water retention, dizziness and constipation.

  Grapefruit juice interacts with some calcium channel blockers, increasing levels of the medication in your blood and putting you at a higher risk of side effects. Ask your doctor or pharmacist if your medication is affected by grapefruit juice.

• Direct renin inhibitors. These medications relax and widen the arteries by prevention the action of a protein (enzyme) called renin. Renin is released by your kidneys and helps control blood pressure. An example of a direct renin inhibitor is as aliskiren (Tekturna).

  Common side effects of aliskiren include dizziness and diarrhea. If you have diabetes or moderate to severe kidney problems, you shouldn't use aliskiren in combination with ACE inhibitors or angiotensin II receptor blockers.

  Treatment for secondary hypertension can sometimes be complicated. You may need more than one medication combined with lifestyle changes to control your high blood pressure. Your doctor will want to see you more frequently — possibly as often as once a month — until your blood pressure is controlled. Your doctor may also recommend that you keep track of your blood pressure at home.