Choosing blood pressure medications
Choosing the right high blood pressure medication can be tricky. Find out which of the various drug options is appropriate for you.
Dozens of high blood pressure medications (anti-hypertensives) are available, each with pros and cons. Your doctor might prescribe more than one high blood pressure medication to treat your condition.
If you have high blood pressure or are at risk of developing it, lifestyle changes can help keep your numbers under control. But you might need medication, as well. Having an effective medication regimen, taking drugs as prescribed, monitoring your blood pressure and making lifestyle changes can help you keep your blood pressure under control.
Whether you’re beginning to develop high blood pressure (prehypertension) or you already have it (hypertension), you can benefit from lifestyle changes that can lower your blood pressure.
Lifestyle changes can reduce or eliminate your need for medications to control your blood pressure.
- Eat a healthy diet, focusing on fruits and vegetables and, especially, reduce the sodium in your diet.
- Maintain a healthy weight.
- Exercise. Get 30 minutes of moderate activity on most days of the week. It’s OK to break up your activity into three 10-minute sessions a day.
- Limit the amount of alcohol you drink. For healthy adults, that means up to one drink a day for women of all ages and men older than 65, and up to two drinks a day for men 65 and younger.
- Don’t smoke.
- Manage stress.
If a trial of making lifestyle changes isn’t enough to control your blood pressure, you’ll likely receive a prescription for one or more of these medications in addition to maintaining your lifestyle measures.
Diuretics (water pills). Your doctor might first suggest diuretics, which remove excess water and sodium from your body. That decreases the amount of fluid flowing through your blood vessels, which reduces pressure on your vessel walls.
There are three types of diuretics: thiazide, loop and potassium-sparing. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that most people try thiazide diuretics first to treat high blood pressure and heart problems related to high blood pressure.
If diuretics aren’t enough to lower your blood pressure, your doctor might recommend adding other blood pressure medications to your treatment.
- Angiotensin-converting enzyme (ACE) inhibitors. These help relax blood vessels by preventing the formation of a hormone called angiotensin, a substance in your body that narrows blood vessels. Frequently prescribed ACE inhibitors include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and ramipril (Altace).
- Angiotensin II receptor blockers (ARBs). These help relax blood vessels by blocking the action, not the formation, of angiotensin, a chemical in your body that narrows blood vessels. ARBs include valsartan (Diovan), losartan (Cozaar) and others.
- Calcium channel blockers. These medications prevent calcium from entering heart and blood vessel muscle cells, thus causing the cells to relax. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and nifedipine (Adalat CC, Afeditab CR, Procardia).
Beta blockers. Also known as beta-adrenergic blocking agents, these work by blocking the effects of the hormone epinephrine, also known as adrenaline. They cause your heart to beat slower and with less force.
Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol-XL), nadolol (Corgard) and atenolol (Tenormin).
- Renin inhibitors. Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows the production of renin, reducing its ability to begin this process.
Other medications sometimes used to treat high blood pressure
If you’re unable to reach your blood pressure goal with one or more of the above medications, other drugs that lower blood pressure include:
Alpha blockers. Alpha blockers relax certain muscles and help small blood vessels remain open. They work by keeping the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller arteries and veins, which causes the vessels to remain open and relaxed.
Frequently prescribed alpha blockers include doxazosin (Cardura), prazosin (Minipress) and terazosin.
- Alpha-beta blockers. Alpha-beta blockers work similarly to beta blockers. They might be prescribed for people with high blood pressure who are at risk of heart failure. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
Central-acting agents. These prevent your brain from sending signals to your nervous system to speed up your heart rate and narrow your blood vessels. As a result, your heart doesn’t pump as hard and your blood flows more easily through your blood vessels.
Clonidine (Catapres, Kapvay), guanfacine (Intuniv, Tenex) and methyldopa are examples of central-acting agents.
Vasodilators. These medications open (dilate) blood vessels. They affect the muscles in blood vessel walls, preventing the muscles from tightening and the walls from narrowing. As a result, blood flows more easily through your vessels and your heart doesn’t have to pump as hard.
Other blood pressure medications, such as calcium channel blockers, also dilate blood vessels. But the vasodilators that work directly on the vessel walls are hydralazine and minoxidil.
- Aldosterone antagonists. These are often used with other drugs, such as a diuretic, for black people, older people, people with heart failure, people with diabetes and people whose hypertension is difficult to treat. Examples are spironolactone (Aldactone) and eplerenone (Inspra).
Each of the blood pressure drugs has been shown to lower blood pressure. However, different people respond better to certain drugs than other people do, which often depends on age, sex, race, how high your blood pressure is and your other health conditions.
A two-drug combination generally is more effective than is a single drug to get your blood pressure under control. Sometimes a third medication, or more, is needed to achieve your blood pressure goal.
High blood pressure and other health problems
High blood pressure often goes hand in hand with other health problems, including:
- Heart failure
- Previous heart attack or stroke
- Coronary artery disease
- Enlarged or thickened left chamber of the heart (left ventricular hypertrophy)
- Chronic kidney disease
High blood pressure itself puts you at higher risk of having one of these conditions. If you already have one or more of these conditions plus high blood pressure, your chance of developing complications increases. A targeted treatment approach might reduce your risk of these complications.
For example, if you have chest pain (angina), your doctor may recommend a beta blocker, which can lower your blood pressure and also prevent your chest pain, reduce your heart rate and decrease your risk of death. If you have diabetes and high blood pressure, taking a diuretic plus an ACE inhibitor can decrease your risk of a heart attack and stroke. If you have diabetes, high blood pressure and kidney disease, you may need an ACE inhibitor or an angiotensin II receptor blocker.
Keep trying to reach your blood pressure goal
It’s not unusual to try several medications or doses before finding what works best for you. An important way for you and your doctor to know if your treatment is working is to monitor your blood pressure at home.
Home blood pressure monitors are widely available and inexpensive, and you don’t need a prescription to buy one. Regular, accurate recordings can help your doctor monitor your treatment program. However, home blood pressure monitoring isn’t a substitute for visits to your doctor, and home blood pressure monitors have some limitations.
In most cases, a combination of lifestyle changes and medication can help you successfully control your blood pressure. Finding the right combination of treatments to keep your blood pressure under control is likely to take time and effort, but it can mean a longer life, with fewer health problems.Jan. 09, 2019
- Kaplan NM, et al. Treatment of hypertension: Drug therapy. In: Kaplan’s Clinical Hypertension. 11th ed. Philadelphia, Pa.: Wollters Kluwer Health/Lippincott Williams & Wilkins; 2015. http://www.ovid.com/site/index.jsp. Accessed June 15, 2016.
- About high blood pressure. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/About-High-BloodPressure_UCM_002050_Article.jsp#.V18Wbma8yyo. Accessed June 14, 2016.
- Fisher NDL, et al. Renin inhibitors. Journal of Clinical Hypertension. 2011;13:662.
- Wong GWK, et al. Blood pressure lowering efficacy of dual alpha and beta blockers for primary hypertension. Cochrane Database of Systemic Reviews. http://ovidsp.tx.ovid.com/sp-3.20.0b/ovidweb.cgi?&S=JLOMFPJPCBDDLJGBNCIKHAFBMHMBAA00&Link+Set=S.sh.18|1|sl_50. Accessed June 16, 2016.
- Epstein M, et al. Aldosterone blockers (mineralocorticoid receptor antagonism) and potassium-sparing diuretics. Journal of Clinical Hypertension. 2011;13:644.
- Mann JFE. Choice of therapy in essential hypertension: Recommendations. http://www.uptodate.com/home. Accessed May 26, 2016.
- Mann FFE. Patient information: High blood pressure treatment in adults (beyond the basics). http://www.uptodate.com/home. Accessed June 17, 2016.