High blood pressure medicines
Hypertension - medicines
Treating high blood pressure will help prevent problems such as heart disease, stroke, loss of eyesight, chronic kidney disease, and other blood vessel diseases.
You may need to take medicines to lower your blood pressure if lifestyle changes are not enough to bring your blood pressure to the target level.
WHEN ARE MEDICINES FOR HIGH BLOOD PRESSURE USED
Most of the time, your health care provider will try lifestyle changes first and check your BP two or more times.
If your blood pressure is 120/80 to 129/80 mm Hg, you have elevated blood pressure.
- Your provider will recommend lifestyle changes to bring your blood pressure down to a normal range.
- Medicines are rarely used at this stage.
If your blood pressure is equal to or higher than 130/80 but lower than 140/90 mm Hg, you have Stage 1 high blood pressure. When thinking about the best treatment, you and your provider must consider:
- If you have no other diseases or risk factors, your provider may recommend lifestyle changes and repeat the measurements after a few months.
- If your blood pressure remains equal to or higher than 130/80 but lower than 140/90 mm Hg, your provider may recommend medicines to treat high blood pressure.
- If you have other diseases or risk factors, your provider may be more likely to recommend medicines at the same time as lifestyle changes.
If your blood pressure is equal to or higher than 140/90 mm Hg, you have Stage 2 high blood pressure. Your provider will most likely recommend that you take medicines and recommend lifestyle changes.
Before making a final diagnosis of either elevated blood pressure or high blood pressure, your provider should ask you to have your blood pressure measured at home, at your pharmacy, or somewhere else besides their office or a hospital.
If you have a higher risk for heart disease, diabetes, heart problems, or a history of a stroke, medicines may be started at lower blood pressure reading. The most commonly used blood pressure targets for people with these medical problems are below 130/80.
MEDICINES FOR HIGH BLOOD PRESSURE
Most of the time, only a single drug will be used at first. Two drugs may be started if you have stage 2 high blood pressure.
Several types of medicine are used to treat high blood pressure. Your provider will decide which type of medicine is right for you. You may need to take more than one type.
Each type of blood pressure medicine listed below comes in different brand and generic names.
One or more of these blood pressure medicines are often used to treat high blood pressure:
- Diuretics are also called water pills. They help your kidneys remove some salt (sodium) from your body. As a result, your blood vessels do not have to hold as much fluid and your blood pressure goes down.
- Beta-blockers make the heart beat at a slower rate and with less force.
- Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) relax your blood vessels, which lowers your blood pressure.
- Angiotensin II receptor blockers (also called ARBs) work in about the same way as angiotensin-converting enzyme inhibitors.
- Calcium channel blockers relax blood vessels by reducing calcium entering cells.
Blood pressure medicines that are not used as often include:
- Alpha-blockers help relax your blood vessels, which lowers your blood pressure.
- Centrally acting drugs signal your brain and nervous system to relax your blood vessels.
- Vasodilators signal the muscles in the walls of blood vessels to relax.
- Renin inhibitors, a newer type of medicine for treating high blood pressure, act by reducing the amount of angiotensin precursors thereby relaxing your blood vessels.
SIDE EFFECTS OF BLOOD PRESSURE MEDICINES
Most blood pressure medicines are easy to take, but all medicines have side effects. Most of these are mild and may go away over time.
Some common side effects of high blood pressure medicines include:
- Diarrhea or constipation
- Dizziness or lightheadedness
- Erection problems
- Feeling nervous
- Feeling tired, weak, drowsy, or a lack of energy
- Nausea or vomiting
- Skin rash
- Weight loss or gain without trying
Tell your provider as soon as possible if you have side effects or the side effects are causing you problems. Most of the time, making changes to the dose of medicine or when you take it can help reduce side effects.
Never change the dose or stop taking a medicine on your own. Always talk to your provider first.
Taking more than one medicine may change how your body absorbs or uses a drug. Vitamins or supplements, different foods, or alcohol may also change how a drug acts in your body.
Always ask your provider whether you need to avoid any foods, drinks, vitamins or supplements, or any other medicines while you are taking blood pressure medicine.
If your doctor told you that you have high blood pressure, you may have wondered, what's the big deal? Well high blood pressure IS a big deal, because it can lead to a heart attack, stroke, vision loss, and kidney disease, sometimes before you even realize you have it. When you have high blood pressure, you'll want to control it before it can lead to these dangerous complications. Let's talk about high blood pressure, otherwise known as hypertension. Blood pressure measures the force at which your blood rushes against the walls of your arteries as your heart pumps it through your body. The higher the force, meaning the higher your blood pressure, the harder your heart has to work. High blood pressure damages not only your heart but also your arteries. When your doctor or nurse measures your blood pressure, you'll see two numbers. The top number is called systolic blood pressure. That's the force of blood in your arteries whenever your heart beats. The bottom number measures diastolic blood pressure, or the force of blood in between heartbeats. You're more likely to have high blood pressure if you don't exercise regularly, you're obese, you eat too much salt, you have diabetes, you smoke, or you have a family history of high blood pressure. Most of the time, you won't know that you have high blood pressure. That's because high blood pressure usually doesn't cause symptoms. Unless you get your blood pressure checked, you may have no idea there's a problem until you develop heart disease or another complication. If your blood pressure is high, a few simple lifestyle changes can help bring it back down, and prevent its complications. Eat a heart-healthy diet that includes plenty of fresh fruits and vegetables, whole grains, and low-fat dairy, avoid fatty, salty, and sugary foods, exercise at least 30 minutes a day, limit salt to 1,500 milligrams or less a day, that's less than a teaspoon per day, and if you smoke, now is the perfect time to quit. Ask your doctor for tips on how to kick the habit. If these measures don't work, your doctor may prescribe one or more medicines to control your blood pressure. Because high blood pressure can sneak in without warning, stop it before it starts. Stay healthy, and your blood pressure checked at least once a year. If you already have high blood pressure, follow your doctor's advice to get it under control.
Victor RG. Arterial hypertension. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 67.
Victor RG, Libby P. Systemic hypertension: management. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier Saunders; 2019:chap 46.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248. PMID: 29146535
Williams B, Borkum M. Pharmacologic treatment of hypertension. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 36.
Last reviewed on: 5/6/2019
Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.