Medicines to reduce high blood pressure

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-2 receptor blockers (ARBs) block the production of angiotensin II, a substance that narrows blood vessels and releases hormones such as aldosterone and norepinephrine which raise blood pressure.
• Calcium channel blockers stop calcium from entering the cells of the heart and arteries. Calcium causes the heart and arteries to squeeze more strongly. Blocking calcium allows blood vessels to relax and open.
• Diuretics, also known as “water pills”, work in the kidneys to help rid the body of extra water and salt.
• Beta blockers, also called beta adrenergic blocking agents, block the release of the stress hormones adrenaline and noradrenaline in certain parts of the body. This slows the heart rate and reduces the force at which blood is pumped around the body.
• Alpha blockers stop a hormone called norepinephrine from tightening the muscles in the walls of smaller arteries and veins. The blood vessels remain open and relaxed, improving blood flow and lowers blood pressure.

Medicines to reduce the formation of blood clots

• Anticoagulants are prescribed to people at risk of developing blood clots which can lead to stroke. They are mostly given to people with atrial fibrillation. They slow down the body’s process of making clots and prevent future clotting by targeting specific proteins in the blood. They can however increase chances of bleeding and may make nosebleeds, for example, take longer to stop.
• Warfarin has been used for many years. People on Warfarin must be carefully monitored and have regular checks to adjust the dose.
• Newer anticoagulants, such as rivaroxaban, dabigatran, apixaban and edoxaban, are generally easier to use and do not require regular check-ups. They are less affected by diet or other medications. However, they are much more expensive.
• Antiplatelets prevent blood clots from forming by making platelets in the blood less likely to stick together. They are usually prescribed to people after they have had a stroke or TIA as a preventative measure. There are four main types of antiplatelet drug: Aspirin; Clopidogrel, Dipyridamole and Glycoprotein IIb/IIIa inhibitors (for example abciximab, eptifibatide, and tirofiban).

Cholesterol medicines

People who have high cholesterol levels that do not come down after they change their diet and exercise are most often prescribed statins normally simvastatin, atorvastatin, pravastatin, fluvastatin and rosuvastatin.Statins reduce production LDL (bad) cholesterol in the liver and lower its levels by between 30% and 50%. Statins can sometimes react unpredictably with other medications and those taking statins are advised not to eat grapefruit.

Diabetes medicines

People with type 1 diabetes and some with type 2 diabetes rely on insulin injections to control the sugar levels in their blood. This is because there is not enough natural insulin being produced in the body. Most people with type 2 diabetes, which is a major risk factor for stroke, will be prescribed other medications:

• Metformin is most commonly prescribed. It prevents the production of glucose in the liver, improving the body’s sensitivity toward insulin and reducing the amount of sugar absorbed by the intestines.
• Sulphonylureas, which works by stimulating the cells in the pancreas to make more insulin.
• Alpha-glucosidase inhibitors slow down the absorption of starchy food after a meal so blood sugar levels will not rise as fast.
• Prandial glucose regulators stimulate the production of insulin in the body and are taken shortly before meals.
• Thiazolidinediones help the body use natural insulin better.
• GLP-1 analogues which act like hormones called incretins, which help make more insulin, reduce the amount of sugar the liver produces and slow digestion speed.

Obesity medications

There are several medicines that can be prescribed to help people with obesity to reduce their weight and appetite.

• Orlistat changes the way fats are digested. It will usually only be recommended after diet, exercise or lifestyle changes have not been successful. In the UK, for example, it is only prescribed if you have either: a body mass index (BMI) of 28 or more, and other weight-related conditions, such as high blood pressure or type 2 diabetes or a BMI of 30 or more.
• Semaglutide and Liraglutide work by making you feel more full and are given by injections. They are only recommended for people who have weight related health problems and a BMI of 35 or more, or 32.5 or more if you are of Asian, Chinese, Middle Eastern, Black African or African-Caribbean origin.