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.
Dozens of different medications can help treat high blood pressure. These drugs are called antihypertensives. They’re divided into many different categories, each of which works differently and causes different side effects.
With so many options available, finding the best one for you may take some time and patience. Your doctor will work with you to find the best treatment plan for you, which may include one or more medications.
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, and loop diuretics. Thiazide diuretics generally have fewer side effects than the others. This is especially true when they’re prescribed in the low doses that are generally used in treating early high blood pressure.
Examples of thiazide diuretics include:
- chlorthalidone (Hygroton)
- chlorothiazide (Diuril)
- hydrochlorothiazide (Hydrodiuril, Microzide)
- indapamide (Lozol)
- metolazone (Zaroxolyn)
Examples of potassium-sparing diuretics include:
- amiloride (Midamor)
- spironolactone (Aldactone)
- triamterene (Dyrenium)
Examples of loop diuretics include:
- bumetanide (Bumex)
- furosemide (Lasix)
- torsemide (Demadex)
Examples of combination diuretics include:
- amiloride hydrochloride/hydrochlorothiazide (Moduretic)
- spironolactone/hydrochlorothiazide (Aldactazide)
- triamterene/hydrochlorothiazide (Dyazide, Maxzide)
Beta-blockers work by blocking the actions of chemicals in your body that stimulate your heart. This allows your heart to beat with less speed and force. Your heart pumps less blood through the blood vessels with each beat, so blood pressure decreases.
Examples of these drugs include:
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.
Examples of ACE inhibitors include:
- benazepril (Lotensin)
- captopril (Capoten)
- enalapril (Vasotec)
- fosinopril (Monopril)
- lisinopril (Prinivil, Zestril)
- moexipril (Univasc)
- perindopril (Aceon)
- quinapril (Accupril)
- ramipril (Altace)
- trandolapril (Mavik)
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.
Examples of ARBs include:
- candesartan (Atacand)
- eprosartan (Teveten)
- irbesartan (Avapro)
- losartan (Cozaar)
- telmisartan (Micardis)
- valsartan (Diovan)
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.
Examples of these drugs include:
- amlodipine (Norvasc, Lotrel)
- diltiazem (Cardizem CD, Cardizem SR, Dilacor XR, Tiazac)
- felodipine (Plendil)
- isradipine (DynaCirc, DynaCirc CR)
- nicardipine (Cardene SR)
- nifedipine (Adalat CC, Procardia XL)
- nisoldipine (Sular)
- verapamil (Calan SR, Covera HS, Isoptin SR, Verelan)
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.
Examples of alpha-blockers include:
- doxazosin (Cardura)
- prazosin (Minipress)
- terazosin (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 do. They also slow down the rate and force of the heartbeat like beta-blockers do.
Examples of alpha-beta-blockers include:
- carvedilol (Coreg)
- labetalol (Normodyne, Trandate)
These 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.
Examples of central agonists include:
- methyldopa (Aldomet)
- clonidine (Catapres)
- guanfacine (Tenex)
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.
Examples of vasodilators include:
- hydralazine (Apresoline)
- minoxidil (Loniten)
Aldosterone receptor antagonists work by blocking a chemical called aldosterone. This action reduces the amount of fluids your body retains, which helps lower your blood pressure.
Examples of aldosterone receptor antagonists include:
- eplerenone (Inspra)
- spironolactone (Aldactone)
A newer type of blood pressure medication is called direct renin inhibitors (DRIs). These drugs 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 is currently available in the United States is:
- aliskiren (Tekturna)
For most people, the first-choice medication for high blood pressure is a thiazide diuretic. For other people, a diuretic alone is not enough to control blood pressure. In these cases, a diuretic may be combined with a beta-blocker, ACE inhibitor, angiotensin II receptor blocker, or calcium channel blocker. Adding a second medication may lower your blood pressure more quickly than using a diuretic alone. Also, it allows you to take less of each medication, which may reduce side effects.
If your doctor thinks you need more than one drug to manage your blood pressure, they may prescribe a combination medication. For instance, they may prescribe a beta-blocker with a diuretic, or an ARB with a calcium channel blocker.
Using these combination medications may be more convenient than taking several different drugs each day.
Many combination medications to treat high blood pressure are available. Examples include:
- triamterene/hydrochlorothiazide (Dyazide) — triamterene and hydrochlorothiazide are both diuretics
- valsartan/hydrochlorothiazide (Diovan HCT) — valsartan is an ARB and hydrochlorothiazide is a diuretic
Treating for multiple conditions
The type of blood pressure medication your doctor prescribes may depend on what other health problems you have. For example, if you have coronary artery disease (CAD) and high blood pressure, your doctor may prescribe a beta-blocker. If you have had a myocardial infarction due to CAD, a beta-blocker can lower your blood pressure and decrease your overall risk of death.
If you have diabetes, your doctor may choose an ACE inhibitor or an ARB. That’s because these drugs can help protect the kidneys from diabetic damage by lowering the blood pressure in your kidneys.
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. Your doctor can tell you which drugs might work best for you. Together, you can put together a treatment plan to get your blood pressure under control.
Some questions to ask your doctor include:
- Do I need medication to control my blood pressure?
- Am I at high risk of certain side effects from blood pressure medication?
- Am I taking any other drugs that might interact with my blood pressure medication?
- Would a combination blood pressure medication be a good option for me?
- Do you recommend improved diet and exercise as a way to lower my blood pressure?