5 essential facts about the blood pressure drug enalapril hydrochlorothiazide
If your doctor has told you that you’ve got hypertension (high blood pressure), you may be heading home with a prescription for enalapril-HCTZ, commonly known by the brand name Vaseretic. It’s a combination of two separate drugs that team up to lower your blood pressure and lower your risk for cardiovascular problems.
“It’s a tried-and-true medication that’s been around since the 1980s,” says Katherine Di Palo, Pharm.D., clinical program manager at Montefiore Health System in New York. “It’s been studied really carefully and most people tolerate it well—and it works very effectively.”
So, if your doctor thinks it’s a good choice for you, you can feel confident about taking it. All medications have the chance of side effects, though, so here’s the information you need to take it safely and effectively.
Enalapril controls high blood pressure .
It belongs to a class of drugs called ACE inhibitors—that’s short for angiotensin-converting enzyme. It works by relaxing and widening your blood vessels, which lowers your blood pressure. This makes it easier for your heart to pump blood throughout your body. And that lowers your risk of having a heart attack or a stroke.
HCTZ (hydrochlorothiazide) controls high blood pressure , too.
It’s part of a drug class called diuretics, also known as water pills. It works by helping your kidneys eliminate sodium and water, which decreases the volume of blood in your body. With less fluid in the blood vessels, there’s less pressure exerted on your heart and cardiovascular system overall.
The two medications together work even better . “Enalapril and HCTZ work synergistically,”explains Tomas Ayala, M.D., a cardiologist at Mercy Medical Center in Baltimore. “With enalapril alone, a patient’s systolic blood pressure may drop by ten points, for example, and with HCTZ, it may drop five points. But with the combination drug, the systolic blood pressure may drop 20 points. The combination is quite effective.”
Here’s another way the two drugs are better together: Enalapril can raise your levels of potassium, which your body needs to regulate your heart rate. HCTZ, on the other hand, can lower it.
“By using the combination, though, it tends to balance out,” says Dr. Ayala. “It’s still important for your doctor to check your potassium levels, but with the combination, it’s less of an issue.”
Plus, it’s easier and often less expensive to take just one pill instead of two. “Enalapril by itself may be the first choice for a patient whose blood pressure is just a little above normal,” says Dr. Ayala. “But when it’s much higher, the combination of enalapril with HCTZ can be a great way to control blood pressure without having to take an additional pill.”
You may have some side effects.
Most are mild, but a few can be serious. “Remember that a side effect can happen after your first dose, or even weeks or months later,” says DiPalo Take the medication exactly as prescribed and if you notice any problems, let your doctor know. Here are a few things to look out for:
- Dizziness or blurry vision.
- If your blood pressure gets too low, you may feel dizzy or light-headed or your eyesight may be a bit blurry. Take your very first dose at night—if you don’t feel dizzy, you can switch to daytime later if you prefer.
- Dry cough.
- DiPalo says that 1 in 10 people on medication containing enalapril experience a tickly, dry cough. “It’s a minor annoyance,” she explains, “but it doesn’t go away as long as you take the medication. If it’s really bothersome, talk to your provider about it. It resolves within a few weeks of stopping the medication.”
- Tummy troubles.
- Some patients may experience nausea or diarrhea. If that happens, try avoiding spicy foods and drink plenty of water. “Stay hydrated,” says DiPalo. “Make sure you’re getting the right fluid intake.”
- Frequent urination.
- Because HCTZ is a “water pill,” you may find yourself heading to the bathroom more often. Try taking your medication first thing in the morning, long before you need to head out the door.
- Muscle cramps.
- HCTZ can lower your potassium levels, which can cause painful muscle cramps. Let your health care team know if you have this problem—they may ask you to take a potassium supplement or add more potassium-rich foods, like bananas and spinach, to your diet.
- That’s a swelling that happens under the surface of your skin, usually in your lips. “It’s extremely rare,” says DiPalo, “but it’s very serious because it can interfere with your breathing. If it happens, go the emergency room right away.”
- Other rare side effects.
- Although these are extremely unlikely, if you have any difficulty breathing, yellowing of the skin or whites of your eyes, or severe skin rash, call your doctor right away or head to the ER.
A follow-up is important .
“If your health care team schedules you for a two-week visit,” says DiPalo, “make sure you keep your appointment. You can expect to have your blood pressure checked, your kidney function monitored, and some blood work done to keep an eye on your potassium levels.”
This is your chance to report on side effects and ask questions—and your doctor’s opportunity to make any adjustments if needed. You may have your dosage adjusted or be asked to follow a special diet.
“It’s important to work with your provider,” says DiPalo, “to find a good regimen that you can tolerate and adhere to.”