Dozens of different medications can help treat high blood pressure (hypertension). These medications are called antihypertensives and are divided into many different categories, each of which works differently.

High blood pressure can lead to many serious health problems, such as heart attack, heart failure, stroke, and kidney disease. Treating high blood pressure early is important in preventing these and other problems.

With so many medication options available, finding the best one for you may take some time and patience. A doctor will work with you to find the best treatment plan for you, which may include one or more medications.

The following chart summarizes the major classes of blood pressure medications, times they’re likely to be prescribed, and their side effects.

NameWhen they’re usedSide effects
DiureticsThese are often used as first-line treatment, particularly the thiazide type.depends on the type, but may lead to low or high potassium or other electrolyte imbalances
Alpha-blockersThese may be used as an additional treatment option or in combination with other drugs.headaches, nausea, dizziness, tremors, and more
Alpha-2 receptor agonistsThese are primarily prescribed for other conditions, such as attention deficit hyperactivity disorder (ADHD) but may be used in unique circumstances. For example, methyldopa may be prescribed during pregnancy, as it’s safer than other drugs.drowsiness or dizziness
Beta-blockersThese may be used when other medications like diuretics don’t work.slow heart rate, cold extremities, insomnia, weight gain, and others
Angiotensin converting enzyme (ACE) inhibitorsThese may be used to treat heart failure or after a heart attack.dry cough, rash, loss of taste, and rarely kidney damage
Angiotensin II receptor blockersThese may be used to treat heart failure or after a heart attack.dizziness, headache, fatigue, and others
Calcium channel blockersThese may be used as an additional treatment option or in combination with other drugs.depends on the type, but may lead to ankle swelling, flushing, constipation, slow heart rate, or heart palpitations
VasodilatorsThese are often used when the systolic blood pressure is greater than 180 millimeters of mercury (mm Hg) and/or the diastolic blood pressure is greater than 120 mm Hg or to treat preeclampsia.headache, eye swelling, joint pain, heart palpitations, weight gain
Aldosterone receptor antagonistsThese are used mainly in cases of heart failure or a concern that heart failure may occur.high potassium and impaired kidney function.
Direct renin inhibitorsOnly one drug, aliskiren, is approved to treat high blood pressure, but it may not be the first choice.diarrhea, cough, rash, headaches, dizziness, and various metabolic imbalances.
Peripheral adrenergic inhibitorsThese are used only in cases when other medications don’t work.diarrhea, heartburn, dizziness, weakness

Diuretics are some of the most commonly used drugs for treating high blood pressure. They help the kidneys get rid of excess water and sodium, or salt. This reduces the volume of blood that needs to pass through your blood vessels, which lowers your blood pressure.

There are three major types of diuretics:

  • thiazide
  • potassium-sparing
  • loop diuretics

Discover everything you need to know about diuretics, their types, and specific examples.

In certain situations, your body makes hormones called catecholamines. These hormones can bind to parts of cells called alpha receptors. When this occurs, your blood vessels narrow, and your heart beats faster and with more force. These actions cause your blood pressure to rise.

Alpha-blockers work by blocking catecholamines from binding to alpha receptors. As a result, blood can flow through the blood vessels more freely, and your heart beats normally. This helps lower your blood pressure.

Alpha-blockers include doxazosin (Cardura, Cardura XL), prazosin (Minipress), and terazosin (Hytrin).

These medications perform the opposite function of alpha-blockers. A blocker (antagonist) is a drug that binds to the receptor, preventing it from triggering any responses.

An agonist, on the other hand, is a drug that binds to the same receptor and stimulates it in a way that’s similar to that of the primary chemical. The primary chemicals, in this case, are alpha-1 or alpha-2 proteins. This calms the sympathetic nervous system, which leads to less production of adrenaline and lower blood pressure.

An example of an alpha-2 agonist is methyldopa. Examples of alpha-1 agonists are phenylephrine (Sudafed PE) and pseudoephedrine (Sudafed).

Another type of alpha receptor agonist is sometimes classified separately as central agonists.

Central agonist medications keep the brain from sending messages to the nervous system telling it to release catecholamines. As a result, the heart doesn’t pump as hard, and blood flows more easily, lowering blood pressure.

Methyldopa (Aldomet) is also considered a central agonist, as are clonidine (Catapres) and guanfacine (Tenex).

Beta-blockers work by blocking the actions of hormones in your body that stimulate your heart. This allows your heart to beat with less speed and force, leading to a decrease in blood pressure.

Beta-blockers can further be divided as follows:

  • Selective: These only block beta-1 receptors found in the heart muscle.
  • Nonselective: These block both beta-1 and beta-2 receptors (found in the lungs and other smooth muscle).

In addition, some beta-blockers have a combined effect. Combined alpha- and beta-blockers block the binding of catecholamine hormones to both alpha- and beta-receptors.

Discover everything you need to know about beta-blockers, their types, and specific examples.

ACE inhibitors keep the body from making a hormone called angiotensin II, which causes blood vessels to narrow. These medications lower blood pressure by helping constricted blood vessels expand to let more blood through. ACE inhibitors aren’t safe to take during pregnancy.

Accupril recall

On April 22, 2022, Pfizer issued a voluntary recall of five lots of the drug quinapril (Accupril) due to the presence of nitrosamine.

Nitrosamine, a chemical known to have the potential to cause cancer, was found to exist in the drug at levels greater than the acceptable daily intake (ADI) as determined by the Food and Drug Administration (FDA).

This recall is specific only to a handful of lot numbers and doesn’t affect all Accupril tablets made by Pfizer. If you take Accupril tablets, talk with a pharmacist or doctor, and they’ll help you determine if your medication has been affected by the recall.

Was this helpful?

Discover everything you need to know about ACE inhibitors, their types, and specific examples.

This class of drugs also protects the blood vessels from angiotensin II. In order to tighten blood vessels, angiotensin II must bind with a receptor site. ARBs prevent that from happening. As a result, blood pressure is lowered.

Like ACE inhibitors, ARBs aren’t safe to take during pregnancy.

Discover everything you need to know about ARBs, their types, and specific examples.

To move, all muscles need calcium to flow in and out of the muscle cells. Calcium channel blockers help block calcium from entering the smooth muscle cells of the heart and blood vessels. This makes the heart beat with less force and helps blood vessels relax. As a result, blood pressure decreases.

There are two categories of calcium channel blockers:

  • Non-dihydropyridine (non-DHP): These have a direct effect on the electrical signals to the heart muscle.
  • Dihydropyridine (DHP): These have an effect on other (peripheral) blood vessels in the body.

Discover everything you need to know about calcium channel blockers, their types, and specific examples.

Vasodilators relax the muscles in the walls of blood vessels, especially in small arteries called arterioles. This widens the blood vessels and allows blood to flow through them more easily. As a result, blood pressure falls.

Discover everything you need to know about vasodilators, their types, and specific examples.

Aldosterone receptor antagonistswork by blocking a chemical called aldosterone. This action reduces the amount of fluid your body retains, which helps lower your blood pressure.

Aldosterone receptor antagonists include eplerenone (Inspra) and spironolactone (Aldactone).

Another type of blood pressure medication is called a direct renin inhibitor (DRI). DRIs block a chemical in your body called renin. This action helps widen your blood vessels, which lowers your blood pressure.

The only type of DRI that’s currently available in the United States is aliskiren (Tekturna).

Peripheral adrenergic inhibitors stop neurotransmitters in the brain from conveying a signal that causes the heart muscle to constrict. This helps lower your blood pressure.

Examples include guanadrel (Hylorel), guanethidine monosulfate (Ismelin), and reserpine (Serpasil).

There are times when you may need to take more than one type of blood pressure medication. Most commonly, this occurs when:

Can exercise help lower my high blood pressure?

Regular exercise strengthens the heart and makes it work more efficiently, leading to lower blood pressure. That said, speak with a doctor about making lifestyle changes to help manage your blood pressure. These include reducing your salt intake, quitting smoking if you smoke, and limiting alcohol consumption.

What is the most common blood pressure medication?

Thiazide or thiazide-like diuretics are often prescribed as the first-line treatment for high blood pressure.

Specifically, the most commonly prescribed blood pressure medications are the ACE inhibitor lisinopril (Prinivil and Zestril), the DHP calcium channel blocker amlodipine (Norvasc), the beta-blocker metoprolol (Lopressor), and the thiazide diuretic hydrochlorothiazide.

What is the best blood pressure medication with the least side effects?

The best blood pressure medication with the fewest side effects will be different for every person, as there are many factors that help determine this.

That said, ACE inhibitors, ARBs, thiazide diuretics, and DHP calcium channel blockers tend to be prescribed in many cases. Each hypertensive medication comes with some chance of side effects, but each may affect different people differently.

High blood pressure is a serious condition that requires treatment to prevent more severe health problems.

Don’t worry if you’re confused by all of your medication options. A doctor can tell you which drugs might work best for you. Together, you can put together a treatment plan to manage your blood pressure.

Read this article in Spanish.