What Are The Best Medications For Diastolic Hypertension?

A healthy person has a blood pressure reading below or equal to 120/80mm Hg. The number on top represents the systolic pressure, or the pressure when the heart contracts to push the blood to the body. The number on the bottom represents the diastolic blood pressure or the force in the periods between heartbeats. To put it simply, diastolic blood pressure is the force exerted by the blood against the arteries’ walls when the heart relaxes and fills with blood.

When we refer to a person having hypertension, it will mostly mean both their systolic and diastolic blood pressures are above normal (120/80mm Hg). But there is another condition known as isolated diastolic hypertension (IDH), where only a person's diastolic blood pressure is high, and the systolic pressure remains normal.

Like regular hypertension, the treatment plan for diastolic hypertension includes making some positive lifestyle changes and medications.

So, what are the best medications to treat diastolic hypertension? This post is a comprehensive guide on the best medications that treat diastolic hypertension.

When should diastolic hypertension be treated?

Diastolic blood pressure is measured between beats when the heart refills with blood. The diastolic blood pressure is considered high when above 80mm Hg. A normal diastolic blood pressure reading should be 80mm Hg or slightly less during quiet rest. However, there are various levels of diastolic hypertension.

When a person’s reading ranges between 80 and 89, they have stage-one (mild) diastolic hypertension. A person has stage-two hypertension if their diastolic blood pressure ranges between 90 and 119. Lastly, if your diastolic blood pressure is 120 and above, this level is categorized as hypertensive crisis, and you may need immediate medical attention.¹

The main lifestyle risk factors associated with diastolic hypertension include smoking, obesity, increased BMI, alcohol, sedentary lifestyle, and high triglyceride.² ³ ⁴

How is diastolic hypertension treated?

Treatment options for diastolic blood pressure involve making lifestyle changes and using medication.

Below are some positive lifestyle changes you can make to manage diastolic hypertension:

Quitting tobacco use

Tobacco has several negative health effects, and you can avoid them by quitting smoking. Smoking can lead to increased plaque buildup in your arteries which can cause narrowing of the blood vessels, commonly known as atherosclerosis.

Tobacco smoking is known to cause acute and temporary increases in blood pressure, while hypertensive smokers are more likely to develop a severe form of chronic hypertension.⁵ So, stopping tobacco use can help lower your blood pressure, reduce your risk of developing heart problems, and at the same time, improve your overall health.

Exercising regularly

You can manage diastolic hypertension by increasing physical activity. Being physically active helps maintain a healthy weight, as obesity is one of the main causes of increased diastolic blood pressure.

You can take up walking, swimming, jogging, dancing or cycling. Additionally, you can alternate high and low-intensity activities in your exercise sessions. If you're unsure of what to include in your exercise program, you can consult your doctor.

Managing stress

Researchers found stress management to help control both systolic and diastolic blood pressure in people with hypertension. Although studies have not found a definitive link between stress and isolated diastolic hypertension, it is always beneficial to keep your stress levels down, as chronic stress can lead to many health conditions.

Drinking alcohol, eating unhealthy foods, or smoking to cope with financial, family, illness, or work-related stress may also contribute to high blood pressure. Instead, try healthier stress coping mechanisms.

For example, you can try to avoid things or people who trigger your stress and make an effort to do fun activities that make you happy.

Limiting your alcohol intake

Drinking moderate amounts of alcohol or, even better, quitting entirely can help reduce your diastolic blood pressure readings by several points. Since alcohol consumption was found to be one of the risk factors associated with isolated diastolic hypertension, limiting your alcohol intake to less than two drinks per day for men and one for women might help.⁶ One drink equates to 1.5 ounces (80-proof liquor), 5 ounces (wine), or 12 ounces (beer).

Taking dietary supplements

Dietary supplements can help manage regular hypertension. There is no harm in taking them, provided you are positive that you don't have renal disease, as some supplements could worsen this and other health conditions.⁷

You should also first discuss the best supplements with your doctor. Some supplements that can help manage regular hypertension include potassium and magnesium.

Potassium counteracts the effects of sodium in the blood and relieves the walls of blood vessels.⁸ Magnesium has many healthy roles, including improving sleep which can help reduce stress levels and lower blood pressure.⁹ You can also take supplements such as ginger or omega fats from oily fish such as mackerel, sardines, and salmon. Omega-3 fatty acids help keep the blood vessels healthy.¹⁰

Lowering your sodium intake

Reducing your salt intake can help manage regular hypertension and often lowers both diastolic and systolic blood pressure.

However, when it comes to IDH, lowering sodium may not have much impact, as high salt intake is not one of the risk factors linked to this condition.³ Sodium found in salt may contribute to regular hypertension (elevated systolic and diastolic) by increasing your body's fluid retention.¹¹ This increases your blood volume and may lead to increased pressure.

You can lower your salt intake by opting for low sodium alternatives when shopping and cutting back on the amount of salt you add to your foods. For example, instead of using table salt, you can use spices and herbs to add flavor to your food.

Eating healthy foods and exercising regularly

While having specific dietary habits doesn’t affect IDH, keeping a healthy weight and low BMI can help manage the condition considering that IDH often affects those with high BMI.

You can try following the Dietary Approaches to Stop Hypertension (DASH) diet.¹² This diet consists of low-fat dairy products, fruits, vegetables, and whole grains and excludes saturated fat and cholesterol. Additionally, aim to stay active.

Other than lifestyle changes, your doctor may prescribe medications to treat diastolic hypertension.

What are the best medications for diastolic hypertension?

Medications are effective in managing high blood pressure. Studies have suggested that due to the higher prevalence of isolated diastolic hypertension in younger people and how it could increase the risk of cardiovascular disease in the future, it is recommended to try and keep the diastolic blood pressure under control, possibly with medications if needed.¹³

Below are medications commonly used to treat both regular hypertension and isolated diastolic hypertension and how they function:

Calcium channel blockers

Calcium penetrates through tiny pores or channels to reach the heart and blood vessels muscles. It aids in the contraction of the heart and arteries to facilitate oxygen and blood flow in the body. However, this could strain people with diastolic hypertension.

Calcium channel blockers medications prevent the entry of calcium by blocking its channels in the smooth muscle cells of the arteries and heart. As a result, the heart contractions are less forceful, and the arteries relax, thus lowering blood pressure and reducing the strain on the heart.

These medications begin to work within four hours after the first dose. Some of them are short-acting, which means their effect disappears after a few hours, but others can be long-acting, with their impact lasting for many hours longer.

Examples of calcium channel blockers that treat diastolic hypertension include:

• Norvasc (amlodipine)

• Cardizem, Tiazac (diltiazem)

Angiotensin-converting enzyme (ACE) inhibitors

These drugs interfere with the body's renin-angiotensin-aldosterone system (RAAS). This system is crucial in regulating blood pressure in the body. When there is a decrease in the arterial blood pressure or the sodium load detected by the kidneys, they release the renin enzyme. The main substrate for renin is another enzyme, angiotensinogen, produced in the liver.

Renin combines with angiotensinogen to form angiotensin I. Using an enzyme called angiotensin-converting enzyme (ACE), it is converted into angiotensin II, which leads to the narrowing of smooth muscles of the blood vessels, thus increasing blood pressure. It also activates aldosterone release, a steroid that triggers sodium reabsorption and potassium excretion, thus increasing blood volume and elevating blood pressure.

ACE inhibitors hinder the production of angiotensin II, thus allowing the widening of blood vessels and consequently lowering your blood pressure. Also, these medications impede the breakdown of bradykinin, a hormone that helps in vasodilation, and increased bradykinin levels cause the widening of blood vessels.

Examples of ACE inhibitors to treat diastolic hypertension include:

• Lotensin (benazepril)

• Captopril

• Prinivil, Zestril (lisinopril)

Angiotensin II receptor blockers (ARBs)

The muscles surrounding blood vessels have angiotensin II receptors on which angiotensin II binds, causing muscle contraction and narrowing of the vessels. The narrowing of blood vessels can cause diastolic hypertension, and angiotensin II receptor blockers (ARBs) block this action, preventing the binding. This enables the blood vessels to widen, leading to lower blood pressure.

These medications have a similar effect to ACE inhibitors but differ in how they work. While ARBs prevent the binding of angiotensin II to the receptors in muscles surrounding blood vessels, ACE inhibitors prevent the formation of angiotensin II.

Below are examples of ARBs to treat high diastolic blood pressure:

• Atacand (candesartan)

• Cozaar (Losartan)

Water pills or diuretics

Diuretics or water pills treat diastolic hypertension by helping the body eliminate sodium and water from the blood, reducing the amount of fluid running through the blood vessels, and consequently decreasing the pressure on them. These medications are put in different categories depending on their specific way of working, including:

Loop diuretics

They inhibit the Na+/K+/2Cl- transporter protein found in the lining of the ascending loop of Henle. This action prevents the reabsorption of salt, thus increasing diuresis.

Osmotic diuretics

These medications inhibit salt and water reabsorption by increasing the osmolarity or osmotic concentration of the blood and renal filtrate.

Thiazide diuretics

These medications inhibit the reabsorption of sodium salts in the distal convoluted tubule in the kidney. They suppress the co-transporter of sodium salts, which means you will excrete more sodium and water in your urine.

Potassium-sparing diuretics

These diuretic medications prevent salt and water retention by blocking the entry of the aldosterone into the cells of the collecting duct or by interfering with the sodium-potassium exchange. Unlike other diuretics, these medications do not lead to potassium loss from the body.

Examples of diuretic medications to treat high diastolic blood pressure include:

• Isosorbide and mannitol (Osmotic diuretics)

• Hydrochlorothiazide (thiazide diuretic)

• Furosemide (loop diuretic)

• Spironolactone (Potassium-sparing diuretic)

Some pills may have more than one type of water pill or combine a water pill with another hypertension drug. Your doctor will determine the best diuretic medication to prescribe for your condition.

Beta-blockers

Nerves in the body and the adrenal gland produce norepinephrine and epinephrine, which act as neurotransmitters, helping the nerves communicate. Typically, the body has beta-1 (β1), beta (β2), and beta (β3) receptors. Beta-blockers block the binding of norepinephrine and epinephrine (adrenaline) to β1 and β2 receptors on organs (heart, blood vessels, and lungs). Once blocked, the heart rate reduces, and the blood vessels enlarge, lowering blood pressure.

Examples of beta-blockers to treat diastolic hypertension include:

• Tenormin (Atenolol)

• Acebutolol

The lowdown

The treatment plan for diastolic hypertension includes making positive lifestyle changes and medications. Lifestyle modifications help manage the condition while improving your general health. However, medications are an important part of the treatment plan as well. They help control high diastolic blood pressure to ensure it does not lead to other health problems.

If you are diagnosed with diastolic hypertension, your doctor will work with you to develop the right treatment plan that suits you best.