Blood Pressure Medication

Written by the Healthline Editorial Team | Published on October 20, 2014
Medically Reviewed by Kenneth R. Hirsch, MD on October 20, 2014

Medications for High Blood Pressure

There are dozens of different medications to treat high blood pressure. They are known as antihypertensives. They are divided into 11 categories based on how they work. 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. It’s well worth the effort since the stakes for your health are so high.

Talk to your doctor to determine the best treatment plan for you.

Diuretics

Diuretics 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 major types of diuretics defined by how they work. Those in the thiazide group generally have fewer side effects than the others, particularly when used at the low doses that are generally used in treating early high blood pressure.

Thiazide diuretics include:

  • chlorthalidone (Hygroton)
  • chlorthiazide (Diuril)
  • hydrochlorothiazide (Hydrodiuril, Microzide)
  • indapamide (Lozol)
  • metolazone (Zaroxolyn)

Potassium-sparing diuretics include:

  • amiloride hydrochloride (Midamor)
  • spironolactone (Aldactone)
  • triamterene (Dyrenium)

Loop diuretics include:

  • bumetanide (Bumex)
  • furosemide (Lasix)
  • torsemide (Demadex)

Combination diuretics include:

  • amiloride hydrochloride + hydrochlorothiazide (Moduretic)
  • spironolactone + hydrochlorothiazide (Aldactazide)
  • triamterene + hydrochlorothiazide (Dyazide, Maxzide)

Beta Blockers

Beta blockers help the heart beat with less speed and force. The heart pumps less blood through the blood vessels with each beat, and blood pressure decreases. These include:

  • 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)
  • pindolol (Visken)
  • propranolol hydrochloride (Inderal)
  • solotol hydrochloride (Betapace)
  • timolol maleate (Blocadren)

Angiotensin Converting Enzyme Inhibitors (ACEI)

ACE inhibitors keep the body from making a hormone called angiotensin II, which causes blood vessels to narrow. These medications decrease blood pressure by helping blood vessels constricted by angiotensin II expand and let more blood through. They include:

  • 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 (ARB)

This class of drugs also protects the blood vessels from angiotensin II. In order to tighten blood vessels, the hormone must bind with a receptor site. These medications keep that from happening. Consequently, blood pressure falls. These medications include:

  • candesartan (Atacand)
  • eprosartan mesylate (Teveten)
  • irbesarten (Avapro)
  • losartin potassium (Cozaar)
  • telmisartan (Micardis)
  • valsartan (Diovan)

Calcium Channel Blockers

Movement of calcium into and out of muscle cells is necessary for all muscle contractions.  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. They include:

  • 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)

Alpha Blockers

Your body produces a type of hormone called a catecholamine when under stress or chronically in some disease states. These hormones, including norepinephrine and epinephrine, cause the heart to beat faster and with more force and they constrict blood vessels, all of which raises the blood pressure. These effects occur when these hormones attach to a receptor.  The muscles around some blood vessels have what are known as alpha adrenergic receptors.  When a catecholamine binds to an alpha receptor, the muscle contracts, the blood vessel narrows and blood pressure rises. These drugs block binding to alpha receptors, so blood is able to flow through the blood vessels more freely, and blood pressure falls. They include:

  • doxazosin mesylate (Cardura)
  • prazosin hydrochloride (Minipress)
  • terazosin hydrochloride (Hytrin)

Alpha-Beta Blockers

Alpha-beta blockers have a combined effect. They block the binding of catecholamine hormones to both alpha and beta receptors. Therefore, they can decrease the constriction of blood vessels like alpha blockers, and slow down the rate and force of the heartbeat like beta blockers. They include carvedilol (Coreg) and labetolol hydrochloride (Normodyne, Trandate).

Alpha-2 Receptor Agonists

These drugs reduce activity in the sympathetic nervous system, like other alpha blockers, which decreases blood pressure. The main biologic difference between them and other alpha blockers is they target only one type of alpha receptor.  They are a first-choice treatment during pregnancy, because they generally pose few risks for the mother or fetus. One example is methyldopa (Aldomet).

Central Agonists

These medications keep the brain from sending messages to the nervous system that would release catecholamines and thus speed up heart rate and tighten blood vessels. The heart doesn’t pump as hard and blood flows more easily, so blood pressure decreases. These include:

  • 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. This 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

Vasodilators relax the muscles in the walls of blood vessels, especially small arteries called arterioles. This widens the blood vessels and allows blood to flow through them more easily. As a result, blood pressure falls. This group includes hydralazine hydrochloride (Apresoline) and 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. However, in many cases the diuretic is combined with another medication in one of these categories:

  • beta blocker
  • ACE inhibitor
  • angiotensin II receptor blocker (ARB)
  • 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.  The choice of an additional blood pressure medication is often influenced by any other health problems you may have.  For example, a patient with coronary artery disease may receive a beta blocker because of its blood pressure lowering properties and because it decreases the overall risk of death.  If you have diabetes in addition to high blood pressure, your doctor may choose an ACE inhibitor or ARB in order to protect the kidneys from diabetic damage and help manage blood pressure.

If these types of medication don’t lower blood pressure enough you can try other types. However, the less commonly used medications may cause more side effects. This is why they are generally reserved for difficult-to-treat cases. 

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