Medications Used to Treat High Blood Pressure

There are many commonly used treatments for high blood pressure (hypertension), which means that no single drug works the same or "best" for everyone.

The wide range of high blood pressure medications to choose from also means that, as long as you and your healthcare provider are patient and persistent, it is extremely likely you'll find an effective and well-tolerated treatment regimen.

Drug Types and Choices in Treatment

There are five major categories of medications that have been proven effective in treating hypertension:

• Thiazide diuretics
• Calcium channel blockers
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers (ARBs)
• Beta blockers

Combination therapy would involve taking two anti-hypertensive medications, each from a different drug category.

Generally speaking, drugs from each of these classes tend to work equally well in controlling hypertension. That said, individuals may respond quite differently. Healthcare providers have no way of predicting this ahead of time, so they and patients must settle for an educated trial-and-error approach.

In “guessing” on the best initial single drug to try, most experts now recommend beginning either with calcium channel blockers and ARB/ACE inhibitors. While there are no hard and fast rules about which drugs to use in which people, there are certain tendencies that are useful in selecting single-drug therapy.

For instance, African American patients tend to do better with thiazide diuretics or calcium channel blockers. In addition, patients with certain medical conditions may benefit from one drug versus another.

For example, individuals with hypertension who also have diabetes or chronic kidney disease with albuminuria (when a person's urine contains high levels of the protein albumin) are generally prescribed an ACE inhibitor or an ARB (if an ACE inhibitor is not tolerated).

Likewise, having a particular medical condition may sway a healthcare provider away from prescribing a certain anti-hypertensive medication. For example, ACE inhibitors are contraindicated in people with a history of angioedema or in women who are pregnant.

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Most Common Hypertension Drugs

It is not possible to list every high blood pressure medication here, but the following list is reasonably complete. The brand name(s) of each drug is listed first, followed by the generic name.

Diuretics

Diuretics ("water pills") increase the amount of sodium and water excreted into the urine by the kidneys. It is thought that diuretics lower blood pressure mainly by reducing the volume of fluid in the blood vessels.

Examples of diuretics commonly used for hypertension:

• Thalidone, also sold as Tenoretic and Clorpres, (chlorthalidone)
• HydroDiuril, also sold as Microzide and Esidrix (hydrochlorothiazide)
• Lozol (indapamide)

Diuretics less commonly used for hypertension include:

• Diamox (acetazolamide)
• Zaroxolyn, also sold as Mykrox (metolazone)
• Midamor (amiloride hydrochloride)
• Bumex (bumetanide)
• Edecrin (ethacrynic acid)
• Lasix (furosemide)
• Aldactone (spironolactone)
• Demadex (torsemide)
• Dyrenium (triamterene)

Calcium Channel Blockers

Calcium channel blockers can reduce blood pressure by dilating the arteries and, in some cases, reducing the force of the heart's contractions.

Examples of calcium channel blockers include:

• Norvasc (amlodipine)
• Cardizem, also sold as Dilacor and Tiazac, (diltiazem)
• Plendil (felodipine)
• DynaCirc (isradipine)
• Cardene (nicardipine)
• Procardia XL, also sold as Adalat CC, (nifedipine)
• Sular (nisoldipine)
• Verelan, also sold as Calan, (verapamil)

ARBs

The angiotensin II receptor blockers (so-called ARBs) also reduce blood pressure by dilating the arteries. ARBs are generally thought of as superior to ACE inhibitors due to better efficacy and fewer adverse effects.

Options include:

• Atacand (candesartan)
• Avapro (irbesartan)
• Cozaar (losartan)
• Micardis (telmisartan)
• Diovan (valsartan)

ACE Inhibitors

The angiotensin-converting enzyme inhibitors (ACE inhibitors) can lower blood pressure by dilating the arteries.

Popular ACE inhibitors include:

• Lotensin (benazepril)
• Capoten (captopril)
• Vasotec, also sold as Vaseretic (enalapril)
• Monopril (fosinopril)
• Prinivil, also sold as Zestril (lisinopril)
• Univasc (moexipril)
• Accupril (quinapril)
• Altace (ramipril)
• Mavik (trandolapril)

Beta-Blockers

Beta-blockers are no longer considered a first-line, single-drug therapy for hypertension unless a patient has ischemic heart disease, heart failure, or arrhythmias. These drugs block the effect of adrenaline on the cardiovascular system, slow the heart rate, and reduce stress on the heart and the arteries.

Some beta-blockers include:

• Sectral (acebutolol)
• Bystolic (nebivolol)
• Tenormin (atenolol)
• Kerlone (betaxolol)
• Zebeta, also sold as Ziac (bisoprolol)
• Cartrol (carteolol)
• Coreg (carvedilol)
• Normodyne, also sold as Trandate (labetalol)
• Lopressor, also sold as Toprol (metoprolol)
• Corgard (nadolol)
• Levatol (penbutolol)
• Inderal, Inderal LA (propranolol)
• Blocadren (timolol)

Less Commonly Used Hypertension Drugs

These options may be considered in certain circumstances, but are less commonly used:

• Catapres (clonidine)
• Cardura (doxazosin)
• Wytensin (guanabenz)
• Tenex (guanfacine)
• Apresoline (hydralazine hydrochloride)
• Aldomet (methyldopa)
• Minipress (prazosin)
• Serpasil (reserpine)
• Hytrin (terazosin)

Combination Drugs for Hypertension

Several clinical trials have been conducted that offer substantial guidance in choosing appropriate combination therapy for hypertension.

The best scientific evidence (from the ACCOMPLISH trial) suggests that clinical outcomes (including the risk of stroke, heart attack, and cardiovascular death) are most improved with combination therapy when a long-acting calcium channel blocker is used together with an ACE inhibitor or an ARB. So, today most healthcare providers will try this combination first.

If the blood pressure remains elevated with combination therapy using a calcium channel blocker plus an ACE inhibitor or ARB drug, a thiazide drug will usually be added as a third drug. And if this combination still fails to control the blood pressure, a fourth drug (usually spironolactone, a non-thiazide diuretic) may be added.

The vast majority of patients with hypertension will achieve successful therapy long before a third or fourth drug needs to be considered. The rare individual who fails to respond adequately to this kind of combination therapy should be referred to a hypertension specialist.

Numerous combination drugs have been marketed for hypertension, and it is almost impossible to keep track of new ones that come along, or old ones that fade away.

The following list includes most of the commonly prescribed combination drugs used for hypertension:

• Moduretic (amiloride and hydrochlorothiazide)
• Lotrel (amlodipine and benazepril)
• Tenoretic (atenolol and chlorthalidone)
• Lotensin HCT (benazepril and hydrochlorothiazide)
• Ziac (bisoprolol and hydrochlorothiazide)
• Capozide (captopril and hydrochlorothiazide)
• Vaseretic (enalapril and hydrochlorothiazide)
• Lexxel (felodipine and enalapril)
• Apresazide (hydralazine and hydrochlorothiazide)
• Prinzide, also sold as Zestoretic (lisinopril and hydrochlorothiazide)
• Hyzaar (losartan and hydrochlorothiazide)
• Aldoril (methyldopa and hydrochlorothiazide)
• Lopressor HCT (metoprolol and hydrochlorothiazide)
• Corzide (nadolol and bendroflumethiazide)
• Inderide (propranolol and hydrochlorothiazide)
• Aldactazide (spironolactone and hydrochlorothiazide)
• Dyazide, also sold as Maxide (triamterene and hydrochlorothiazide)
• Tarka (verapamil extended-release and trandolapril)

Avoiding Adverse Effects

Any of the drugs used to treat hypertension has the potential of causing problems. And when choosing the best drug regimen for treating a person with hypertension, it is critical to find a drug (or drugs) that not only effectively reduces blood pressure, but that is also well tolerated.

In general, lower doses of blood pressure medicine are as effective as higher doses and cause fewer side effects.

While each of the myriads of hypertension drugs has its own individual side effect profile, for the most part, the potential adverse effects of these drugs are related to their category.

The major category-related adverse effects are:

• Thiazide diuretics: Hypokalemia (low potassium levels), frequent urination, worsening of gout
• Calcium channel blockers: Constipation, swelling of the legs, headache
• ACE inhibitors: Cough, loss of sense of taste, hyperkalemia (elevated potassium levels)
• ARBs: Allergic reactions, dizziness, hyperkalemia
• Beta-blockers: Worsening of dyspnea in people with chronic obstructive pulmonary disease (COPD) or asthma; sexual dysfunction; fatigue; depression; worsening of symptoms in people with peripheral artery disease

Indications

The American College of Cardiology and the American Heart Association define and stage hypertension as follows. The extent of your hypertension, as indicated by these criteria, helps dictate which treatment course may be best for you. Blood pressure (BP) is measured in millimeters of mercury (mmHg).

If there is a difference between the systolic pressure (top number) and diastolic blood pressure (bottom number), the higher one determines the stage.

Deciding When Medication Is Needed

Healthcare providers generally use a stepwise approach to managing hypertension in their patients. For the vast majority of people, the goal of treatment is to achieve a blood pressure of less than 120/80 mmHg.

Step 1 involves engaging in lifestyle modifications that have been shown to reduce blood pressure. These include adopting a heart-healthy diet, losing weight (if needed), participating in regular exercise, and so on.

These changes may be implemented alone, but may or may not be sufficient to manage your condition. Given this, they may also be used in combination with one or more high blood pressure medications.

Deciding whether or not to start medication for your high blood pressure requires a thoughtful discussion with your healthcare provider. In some cases, the decision is obvious. For example, medication is strongly advised if a patient has hypertension and another medical condition, like type 2 diabetes mellitus.

That said, other cases are less straightforward. For example, if you are over the age of 75, the potential risks of taking medication may not outweigh the potential benefits.

A Word From Verywell

Hypertension is an extremely common medical problem that can have severe consequences if not treated adequately. However, with so many treatment options, you should expect your healthcare provider to find a therapeutic regimen that will greatly decrease your risk of a bad outcome from hypertension—without disrupting your everyday life. If you are experiencing any troublesome side effects, be sure to talk to your practitioner about finding a treatment regimen that you can tolerate better.