More than two-thirds of Americans who have been diagnosed with high blood pressure take medication to help manage their condition. Today there are dozens of different blood-pressure-lowering medications, known as antihypertensives. Each has its own benefit and side effect profile. With so many options available, finding the best one for you sometimes takes a little time and patience. But it is well worth the effort, because the health stakes are so high.
High blood pressure medications can be divided into 11 categories based on how they work.
Diuretics, sometimes called water pills, help the kidneys get rid of excess water and salt (sodium). This reduces the volume of blood that needs to pass through the blood vessels, and blood pressure goes down. There are three different types of diuretics. Those in the thiazide group generally have fewer side effects than the others.
- chlorthalidone (Hygroton)
- chlorthiazide (Diuril)
- furosemide (Lasix)
- hydrochlorothiazide (Hydrodiuril, Microzide)
- metolazone (Zaroxolyn)
- amiloride hydrochloride (Midamor)
- spironolactone (Aldactone)
- triamterene (Dyrenium)
- amiloride hydrochloride + hydrochlorothiazide
- spironolactone + hydrochlorothiazide (Aldactazide)
- triamterene + hydrochlorothiazide (Dyazide, Maxzide)
Beta blockers help the heart beat with less speed and force. The heart pumps less blood through the blood vessels, and blood pressure decreases.
- acebutolol (Sectral)
- atenolol (Tenormin)
- betaxolol (Kerlone)
- bisoprolol fumarate (Zebeta)
- bisprolol + hydrochlorothiazide (Ziac)
- carteolol hydrochloride
- metoprolol tartrate (Lopressor)
- metoprolol succinate (Toprol-XL)
- nadolol (Corgard)
- penbutolol sulfate (Levatol)
- propranolol hydrochloride (Inderal)
- sotalol hydrochloride (Betapace)
- timolol maleate
Angiotensin converting enzyme (ACE) inhibitors
ACE inhibitors keep the body from making a hormone called angiotensin II, which causes blood vessels to narrow. By helping blood vessels expand and let more blood through, these medications decrease blood pressure.
- benazepril hydrochloride (Lotensin)
- captopril (Capoten)
- enalapril maleate (Vasotec)
- fosinopril sodium (Monopril)
- lisinopril (Prinivil, Zestril)
- moexipril (Univasc)
- perindopril (Aceon)
- quinapril hydrochloride (Accupril)
- ramipril (Altace)
- trandolapril (Mavik)
Angiotensin II receptor blockers
This class of drugs also protects the blood vessels from angiotensin II. To tighten blood vessels, the hormone must bind with a receptor site, and these medications keep that from happening. Consequently, blood pressure falls.
- candesartan (Atacand)
- eprosartan mesylate (Teveten)
- irbesartan (Avapro)
- losartan potassium (Cozaar)
- telmisartan (Micardis)
- valsartan (Diovan)
Calcium channel blockers
These drugs keep calcium from entering the smooth muscle cells of the heart and blood vessels. This makes the heart beat less forcefully and helps blood vessels relax. As a result, blood pressure decreases.
- amlodipine besylate (Norvasc, Lotrel)
- bepridil (Vasocor)
- diltiazem hydrochloride (Cardizem CD, Cardizem SR, Dilacor XR, Tiazac)
- felodipine (Plendil)
- isradipine (DynaCirc, DynaCirc CR)
- nicardipine (Cardene SR)
- nifedipine (Adalat CC, Procardia XL)
- nisoldipine (Sular)
- verapamil hydrochloride (Calan SR, Covera HS, Isoptin SR, Verelan)
These drugs decrease nerve impulses that tighten blood vessels. Blood is able to flow through the blood vessels more freely, and blood pressure falls.
- doxazosin mesylate (Cardura)
- prazosin hydrochloride (Minipress)
- terazosin hydrochloride (Hytrin)
Alpha-beta blockers have a combined effect. They reduce nerve impulses like alpha blockers and slow down the heartbeat like beta blockers.
- carvedilol (Coreg)
- labetalol hydrochloride (Normodyne, Trandate)
Alpha-2 receptor agonists
These drugs reduce activity in the sympathetic nervous system, which decreases blood pressure. They are a first-choice treatment during pregnancy, because they generally pose few risks for the mother or fetus.
These medications keep the brain from sending messages to the nervous system that speed up heart rate and tighten blood vessels. The heart doesn’t pump as hard and blood flows more easily, so blood pressure decreases.
- alpha methyldopa (Aldomet)
- clonidine hydrochloride (Catapres)
- guanabenz acetate (Wytensin)
- guanfacine hydrochloride (Tenex)
Peripheral adrenergic inhibitors
This group of drugs work to block certain chemical messengers inside the brain, which keeps the smooth muscles from getting the message to constrict. These medications are generally used only if other medications aren’t effective.
- guanadrel (Hylorel)
- guanethidine monosulfate (Ismelin)
- reserpin (Serpasil)
Vasodilators relax the muscles in the walls of blood vessels, especially small arteries called arterioles. This widens the blood vessels, allowing blood to flow through them more easily. As a result, blood pressure falls.
- hydralazine hydrochloride (Apresoline)
- minoxidil (Loniten)
High Blood Pressure Drug Treatment Plans
The first-choice medication for high blood pressure is usually a thiazide diuretic. For some people, a diuretic alone is enough to control blood pressure. In many cases, however, the diuretic is combined with another medication—most commonly, a beta blocker, ACE inhibitor, angiotensin II receptor blocker, or calcium channel blocker. Adding a second medication may lower blood pressure more quickly than a diuretic alone. It also allows you to take less of each medication, which may reduce side effects.
If these types of medication don’t lower blood pressure enough, other types may be tried. However, the less commonly used medications may cause more side effects, which is why they are generally reserved for difficult-to-treat cases. If you have another health condition in addition to high blood pressure, that may influence the choice of medication as well. For example, if you have chest pain (angina), a beta blocker may not only lower your blood pressure, but also help prevent the pain.