Common and less common adverse effects of antihypertensives: a general practitioner’s perspective

Abstract

About 35% of hypertensive patients will discontinue their medication within six months,¹ and in at least 50% of cases, the reason for discontinuation relates to adverse effects and patient dissatisfaction.² Therefore, it is imperative that hypertension practitioners are fully cognisant of the adverse effects of antihypertensive drugs. The focus in this article will be on the six major classes of drugs, namely diuretics, angiotensin-converting (ACE) inhibitors, angiotensinreceptor blockers (ARBs), calcium-channel blockers, beta blockers and alpha blockers.³ The most universal adverse effect of antihypertensive therapy is hypotension, due to overtreatment. This can be subtle, and includes vague symptoms of dizziness, fatigue, tiredness, and anxiety. This is often not detected in the consulting room because of counter-regulatory measures to restore the blood pressure (BP), white-coating (especially in the elderly), and failure to perform a standing BP. Another clue to overtreatment is an unexplained increase in creatinine. Home and 24-hour ambulatory BP monitoring are useful in detecting this.