Treatment for high blood pressure typically involves a combination of medication and lifestyle changes to help control the condition and prevent or delay related health problems. The goal is to get blood pressure below the high range.
A normal blood pressure is 120/80 or lower. When the systolic blood pressure (the top number) is between 121-139 and the diastolic blood pressure (the lower number) is between 81-89, this is a condition known as prehypertension. While prehypertension doesn’t necessarily raise your risk for heart attack or stroke, without attention, it will usually progress to full high blood pressure, which definitely does raise those risks.
High blood pressure, also known as hypertension, is present once the blood pressure is 140/90 and above.
A healthy lifestyle is the first line of defense against high blood pressure. Habits that help control blood pressure include:
- eating a healthy diet
- staying physically active
- maintaining a healthy weight
- avoiding excessive alcohol
- quitting smoking and avoiding secondhand smoke
- managing stress
- eating less salt
- limiting caffeine
- monitoring blood pressure at home
- getting support from family and friends
Some people find that lifestyle changes alone are enough to tame their high blood pressure. Many also take medication to treat their condition. There are numerous different types of blood pressure medication with different modes of action. If one doesn’t lower blood pressure enough, another might do the job. For some people, a combination of two or more drugs may be needed in order to keep blood pressure under control.
High blood pressure medications can be divided into 11 categories based on how they work. The example drugs in each section are just a sampling of what’s available.
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 as a result, blood pressure goes down. There are three major types of diuretics defined by how they work. They include:
- thiazide diuretics (Hygroton, Diuril, Lasix, etc.)
- potassium-sparing diuretics (Midamor, Aldactone, Durenium)
- loop diuretics (bumetanide, furosemide)
- combination diuretics which include more than one variety used together
Diuretics 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.
Beta blockers help the heart beat with less speed and force. The heart pumps less blood through the blood vessels and blood pressure decreases. There are many drugs within this classification, including:
- acebutolol (Sectral)
- betaxolol (Kerlone)
- metoprolol tartrate (Lopressor)
- metoprolol succinate (Toprol-XL)
- penbutolol sulfate (Levatol)
Angiotensin-Converting Enzyme (ACE) Inhibitors
ACE inhibitors keep the body from making a hormone (angiotensin II) that causes blood vessels to narrow. These medications decrease blood pressure by helping blood vessels expand and let more blood through. Some ACE inhibitors include:
- benazepril hydrochloride (Lotensin)
- captopril (Capoten)
- enalapril maleate (Vasotec)
- fosinopril sodium (Monopril)
- lisinopril (Prinivil, Zestril)
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 on the blood vessels. These medications keep that from happening. Consequently, blood pressure falls. These include:
- candesartan (Atacand)
- eprosartan mesylate (Teveten)
- irbesartan (Avapro)
- losartan 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. Examples of these include:
- amlodipine besylate (Norvasc, Lotrel)
- felodipine (Plendil)
- isradipine (DynaCirc, DynaCirc CR)
- verapamil hydrochloride (Calan SR, Covera HS, Isoptin SR, Verelan)
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. These effects raise blood pressure, and 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. These drugs include doxazosin mesylate (Cardura), prazosin hydrochloride (Minipress), and terazosin hydrochloride (Hytrin).
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. Carvedilol (Coreg) and labetalol hydrochloride (Normodyne) are common alpha-beta blockers.
Like other alpha blockers, these drugs reduce activity in the sympathetic nervous system, 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. Methyldopa (Aldomet) is a common form of this type of drug.
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 works 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. They include:
- guanadrel (Hylorel)
- guanethidine monosulfate (Ismelin)
- reserpine (Serpasil)
Vasodilators relax the muscles in the walls of blood vessels, especially small arteries (arterioles). This widens the blood vessels and allows blood to flow through them more easily. Blood pressure falls as a result. Hydralazine hydrochloride (Apresoline) and minoxidil (Loniten) are examples of these.
To make the most of your treatment, it’s vital to get regular medical checkups and blood pressure tests. Regular checkups allow your doctor to monitor how well treatment is going and make any necessary adjustments to your treatment plan. If your blood pressure starts inching back up, your doctor can respond promptly. Doctor visits also give you an opportunity to ask questions and bring up any concerns.
Additional treatment options may be needed in certain situations like resistant hypertension or secondary hypertension.
Resistant hypertension refers to blood pressure that remains high after trying at least three different types of blood pressure medication. Someone whose high blood pressure is controlled by taking four different kinds of medication is also considered to have resistant hypertension. Even such hard-to-treat cases can often be managed successfully in time. The doctor might prescribe a different medication, dose, or drug combination. Or the doctor might recommend more aggressive lifestyle changes.
Secondary hypertension is high blood pressure that is directly caused by another health problem or drug side effect. Blood pressure often drops substantially or even goes back to normal once the root cause is diagnosed and treated.
The first-line treatment for children and teens with high blood pressure is a healthy lifestyle. This includes a balanced diet, regular exercise, and weight loss for those who are overweight or obese. Children may also take the same blood pressure medications as adults when necessary. For children with secondary hypertension, blood pressure often returns to normal once the underlying condition is treated.