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High blood pressure medications

Hypertension - medicines

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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, or a history of a stroke, medicines may be started at lower blood pressure readings. 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, with you, 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 don't have to hold as much fluid and your blood pressure goes down.
• Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) reduce the production of angiotensin II in your body. This helps relax your blood vessels, which lowers your blood pressure.
• Angiotensin II receptor blockers (also called ARBs) reduce the action of angiotensin II in your body. This helps relax your blood vessels, which lowers your blood pressure.
• Calcium channel blockers relax blood vessels by reducing calcium entering cells in the wall of the blood vessels.

One category of blood pressure medicines that has been commonly used but is now usually only used if the drugs above are not adequate or cannot be used is beta-blockers. These medicines make the heart beat at a slower rate and with less force.

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 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:

• Cough
• Diarrhea or constipation
• Dizziness or lightheadedness
• Erection problems
• Feeling nervous
• Feeling tired, weak, drowsy, or a lack of energy
• Headache
• 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.

OTHER TIPS

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.

References

Bakris GL, Sorrentino MJ. Systemic hypertension: mechanisms, diagnosis, and treatment. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 26.

Centers for Disease Control and Prevention website. Blood pressure medicines. www.cdc.gov/bloodpressure/medicines.htm. Updated January 23, 2020. Accessed September 11, 2023.

Flack JM. Arterial hypertension. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 64.

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 pubmed.ncbi.nlm.nih.gov/29146535/.

Williams B. Pharmacologic treatment of hypertension. In: Johnson RJ, Floege J, Tonelli M, eds. Comprehensive Clinical Nephrology. 7th ed. Philadelphia, PA: Elsevier; 2024:chap 37.

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Review Date: 8/20/2023  

Reviewed By: Jacob Berman, MD, MPH, Clinical Assistant Professor of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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