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Many people with high blood pressure require prescription medication to control hypertension. Primary care providers can choose from a wide range of drugs to treat the condition. Knowing the difference between them can help you better understand your treatment plan.

 The most commonly prescribed medications for high blood pressure include:

  • ACE inhibitors
  • Angiotensin II receptor blockers
  • Diuretics
  • Calcium channel blockers
  • Beta blockers

Which is the best medicine for high blood pressure?

There is no single best medicine for high blood pressure. Doctors often prescribe more than one blood pressure medication to improve outcomes. This is known as polytherapy.

Which blood pressure medication is right for you depends on your:

  • Lifestyle
  • Age
  • Other health conditions
  • Risk of developing other health conditions
  • What other drugs and supplements you take

Doctors may also consider insurance coverage when selecting blood pressure medications to ensure that co-pays, co-insurance and out-of-pocket costs don’t put a financial burden on patients.

There are many classes of drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of high blood pressure. 

Diuretics for high blood pressure

Diuretics work by eliminating excess sodium and water from the body to lower blood pressure. Some people call a diuretic a water pill for high blood pressure.

There are four types of diuretics:

Thiazide diuretics

These medications increase how much salt and water your kidneys remove and include:

  • Chlorthalidone (Hygroton)
  • Chlorothiazide (Diuril)
  • Hydrochlorothiazide (Esidrix, Hydrodiuril, Microzide)
  • Indapamide (Lozol)
  • Metolazone (Mykrox, Zaroxolyn)

Common side effects of thiazide diuretics include headache, loss of appetite, hair loss, and electrolyte abnormalities.

Loop diuretics

These drugs act on a part of the kidney called the loop of Henle to help remove salt and water from the body and include:

  • Bumetanide (Bumex)
  • Furosemide (Lasix)

Common side effects of loop diuretics include dizziness, diarrhea and upset stomach.

Potassium-sparing diuretics

These medications increase the removal of salt and water but help to reduce the risk of potassium deficiency and include:

  • Amiloride hydrochloride (Midamar)
  • Spironolactone (Aldactone)
  • Triamterene (Dyrenium)

Common side effects of potassium-sparing diuretics include gas, nausea and headache.

Combination diuretics

Combination diuretics contain a combination of hydrochlorothiazide and a potassium-sparing diuretic. These drugs give you the benefits of a thiazide diuretic plus amiloride hydrochloride, triamterene or spironolactone for high blood pressure. Common side effects include headache and increased urination.

Beta-blockers for high blood pressure

Beta-blockers slow down heart rate, reducing strain on the heart and decreasing the amount of blood the heart puts out with each pump. As a result, your blood pressure levels decrease. Beta-blocker medications include:

  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Betaxolol (Kerlone)
  • Bisoprolol fumarate (Zebeta)
  • Carteolol hydrochloride (Cartrol)
  • Metoprolol succinate (Toprol-XL)
  • Metoprolol tartrate (Lopressor)
  • Nadolol (Corgard)
  • Penbutolol sulfate (Levatol)
  • Pindolol (Visken)
  • Propranolol hydrochloride (Inderal)
  • Sotalol hydrochloride (Betapace)
  • Timolol maleate (Blocadren)

Doctors may also prescribe hydrochlorothiazide and bisoprolol (Ziac), a drug that combines a thiazide diuretic with a beta-blocker.

Some of the potential side effects of beta-blockers include:

  • Changes in blood sugar levels in people with diabetes
  • Cold hands and feet
  • Depression
  • Erectile dysfunction
  • Fatigue
  • Trouble sleeping

ACE inhibitor drugs for high blood pressure

Angiotensin-converting enzyme (ACE) inhibitors reduce the body’s production of angiotensin, a chemical that causes blood vessels to constrict. This relaxes the blood vessels and allows them to open up to decrease blood pressure. Some ACE inhibitors 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)

When taking an ACE inhibitor like lisinopril for high blood pressure, you may experience side effects such as:

  • Dry cough
  • Dizziness
  • Erectile dysfunction
  • Fatigue
  • Headache
  • Skin rash
  • Angioedema or swelling of the skin

ARBs for high blood pressure

Angiotensin II receptor blockers (ARBs) bind to the places where angiotensin normally attaches. This interferes with the action of the chemical to lower blood pressure. Some ARBs include:

  • Candesartan (Atacand)
  • Eprosartan mesylate (Teveten)
  • Irbesartan (Avapro)
  • Losartan potassium (Cozaar)
  • Telmisartan (Micardis)
  • Valsartan (Diovan)

Common side effects of ARBs include:

  • Dizziness
  • Increased levels of potassium
  • Angioedema or swelling of the skin

Calcium channel blockers for high blood pressure

Calcium channel blockers keep calcium from going inside muscle cells in the heart and arteries. This reduces the force of the heart’s contractions to relax blood vessels and lower blood pressure. Some calcium channel blockers include:

  • Amlodipine besylate (Norvasc, Lotrel)
  • Bepridil (Vascor)
  • 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)

Possible side effects of calcium channel blockers include:

  • Constipation
  • Dizziness
  • Headache
  • Heart palpitations
  • Swelling of the ankles 

Alpha blockers for high blood pressure

Alpha blockers lessen nerve impulses to the blood vessels, relaxing the blood vessels, allowing blood to flow more easily through arteries to lower blood pressure. Some alpha blockers include:

  • Doxazosin mesylate (Cardura)
  • Prazosin hydrochloride (Minipress)
  • Terazosin hydrochloride (Hytrin)

Some side effects of alpha blockers are:

  • Blood pressure level drops upon standing
  • Dizziness
  • Rapid heartbeat

Alpha-2 Receptor Agonists for high blood pressure

Alpha-2 Receptor Agonists act on the nervous system to lower blood pressure. Methyldopa is the most commonly prescribed drug of the class. This blood pressure medication is often prescribed for pregnant women because it rarely causes complications during pregnancy.

Combined alpha and beta-blockers

Combined alpha- and beta-blockers act on the nervous system to reduce your heart rate and lower your blood pressure. Carvedilol (Coreg) is an example of this type of drug. Doctors may also prescribe it for the treatment of heart failure. However, the carvedilol dosages for high blood pressure and heart failure are different.

Central agonist blood pressure medications

Central agonists act on a different part of the nervous system to relax blood vessels and lower your blood pressure. Some central agonists include:

  • Alpha methyldopa (Aldomet)
  • Clonidine hydrochloride (Catapres)
  • Guanabenz acetate (Wytensin)
  • Guanfacine hydrochloride (Tenex)

Some side effects of central agonists include:

  • Drop in blood pressure when upright
  • Dry mouth
  • Constipation
  • Drowsiness

Common high blood pressure medication FAQs

Why is my blood pressure still high on medication?

When blood pressure levels remain high despite taking medication, the cause may be:

  • Aspects of your lifestyle, such as your diet or lack of exercise
  • Hormonal imbalances
  • Buildup of plaque in blood vessels leading to the kidneys
  • Sleep apnea
  • Obesity
  • Using substances that increase blood pressure like nicotine and caffeine

Discuss your concerns with your primary care provider. They can work with you to determine the cause. 

How many high blood pressure readings is a sign I need medication?

How many high blood pressure readings you can have before your primary care provider recommends medication depends on a number of factors, including:

  • How high your blood pressure is:  Your doctor may prescribe medications if:
    • Systolic pressure ≥180 mmHg or diastolic pressure ≥120 mmHg, defined as hypertensive emergency or severe hypertension
    • Office systolic pressure ≥160 mmHg and/or diastolic ≥100 mmHg with signs of organ damage on labs or physical exam
    • Average home systolic pressure ≥130 mmHg and/or diastolic ≥80 mmHg
  • How at risk you are for heart attack, heart disease or stroke: If you have another risk factor like high cholesterol, your doctor may prescribe medication sooner.
  • What other health conditions you have: If you have a medical condition that causes high blood pressure like sleep apnea or thyroid disease, you may need medication sooner.

Side effects of high blood pressure medication

All blood pressure medications pose some risk for side effects, but this doesn’t mean that everyone who takes a drug experiences side effects. If you do develop a side effect from a blood pressure medication, consult your doctor before you stop taking it.

Which high blood pressure medication has the least side effects?

All medications pose a risk for side effects. When selecting the right medication for you, your doctors will consider how likely you are to experience side effects and how potential side effects may affect you. A study published in the journal Hypertension found that angiotensin receptor blockers (ARBs) may cause fewer side effects than angiotensin-converting enzyme (ACE) inhibitors. However, ACE inhibitors may still be a better choice for some people.

Which high blood pressure medications cause dry mouth?

A number of high blood pressure drugs, including alpha blockers, beta blockers, ACE inhibitors and diuretics, can cause dry mouth. Try chewing gum, using a mouth-hydrating mouthwash, or sipping frequently on water to combat this side effect.

Which high blood pressure medication causes a cough?

ACE inhibitors like Lisinopril can cause a persistent dry cough. This is because the drugs may allow substances to build up in the airways, leading to inflammation and irritation.

Which high blood pressure medications cause hair loss?

Thiazide diuretics, beta-blockers and ACE inhibitors can cause thinning hair and hair loss. In most cases, the hair loss is not permanent.

Which high blood pressure medications cause edema?

Calcium channel blockers may cause edema or swelling in the ankles. ACE inhibitors can lead to angioedema, which is swelling of the deep layers of the skin that can impact the eyes, lips and tongue. 

Anxiety is not a common side effect of high blood pressure medications. However, people with anxiety often develop high blood pressure. Coping mechanisms for anxiety like smoking or drinking alcohol in excess can increase the risk of hypertension.

Which high blood pressure medication causes erectile dysfunction?

Thiazide diuretics, loop diuretics and beta-blockers for high blood pressure may cause erectile dysfunction. This is because these medications may limit blood flow to the penis.

What high blood pressure meds cause tinnitus?

Loop diuretics, beta-blockers, ACE inhibitors and angiotensin receptor blockers (ARBs) have the potential to cause ringing in the ears or tinnitus.

Is there over-the-counter high blood pressure medication?

No, there is no FDA-approved over-the-counter medication for high blood pressure. While you can buy the diuretic pamabrom without a doctor’s prescription, the FDA has only approved it for treating water retention related to premenstrual syndrome (PMS). Do not try to treat hypertension on your own with over-the-counter diuretics — or any other OTC medications, including vitamins and supplements.

How Forward can help you manage high blood pressure

Developing an effective treatment plan for high blood pressure requires ongoing support and biometric monitoring. Our 12-week, doctor-led Healthy Heart program serves as a starting point for treatment. It allows you to gain a clear picture of your heart health risks and to get an optimized exercise and diet plan to complement the actions of blood pressure medications. We act as your primary care provider, tracking your progress and modifying the treatment plan as needed to help you achieve your health goals.

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