What You Need To Know About High Blood Pressure Medication

According to the Centers for Disease Control and Prevention, an estimated 116 million Americans¹ — one in two adults in the US — have high blood pressure; what’s worse is that 20% don't even know that they have this condition. The US isn't the only country facing a high blood pressure crisis — it is estimated that 26% of the world's population has hypertension², and the prevalence is expected to rise to 29% by 2025. Failure to manage and treat high blood pressure can lead to serious health issues like stroke, kidney disease, heart attack, or heart failure.

So what can you do about hypertension? Altering some of your habits can make a huge difference. This may include lifestyle changes such as quitting smoking, reducing your alcohol intake, getting more exercise, losing weight, and eating a healthy diet. However, lowering blood pressure without using the medication can be incredibly difficult for some people.

Keep reading to learn more about high blood pressure medications.

What is the most common medication used to treat high blood pressure?

There are various types of high blood pressure medications, and the one you will take depends on:

• What's causing the condition

• Your blood pressure level

• Your body's response to the medication

• Other drugs you may be taking

There are times when two medications work better than one when treating high blood pressure. In addition, it may take a while for your doctor to figure out which medicine combination works best for you.

It's also crucial that you maintain a healthy lifestyle while taking the medications for more effective results — and some people have even been able to safely get off their medications by making sustained lifestyle changes.

The more common medications used to treat high blood pressure include:

• Diuretics

• Alpha-blockers

• Angiotensin II receptor blockers

• Calcium channel blockers

• Peripheral adrenergic blockers

• Beta-blockers

• ACE inhibitors

• Direct renin inhibitors

• Central agonists

• Vasodilators

It is important to initially consult a medical professional to evaluate and discuss the best course of treatment for you. You may need to take different high blood pressure medications to achieve adequate control.

Once it is determined that you will be on antihypertensive medication, make sure to take it exactly as prescribed. Don’t change the dose or stop taking it without talking to your healthcare professional first, or it could lead to serious health consequences.

How does medication work in treating high blood pressure?

Diuretics

Often referred to as water pills, diuretics are frequently the first type of medication prescribed for high blood pressure. They work by reducing the reabsorption of sodium in the kidneys. That means you will excrete sodium through your urine, and the extra fluid goes with it. This reduces the volume of blood in your circulatory system, which lowers blood pressure.

The main types of diuretics prescribed today include thiazide, loop, and potassium-sparing diuretics. The primary difference between them is their potency and site of action in the kidney.

Thiazide diuretics are the most commonly used diuretics. In addition to reducing fluids, thiazides help the blood vessels to relax. They are sometimes taken in combination with other medications to reduce high blood pressure. Examples of thiazide diuretics include chlorthalidone, metolazone, hydrochlorothiazide, and indapamide.

Loop diuretics are more potent than thiazides. They are primarily used to treat people allergic to thiazides and are also prescribed to people with heart or kidney failure. They are called loop diuretics because they prevent the reabsorption of water in the portion of the kidney called the loop of Henle. This ensures that water leaves the body more easily, reducing the blood volume and the pressure it creates on the circulatory system — which is the blood pressure. Common loop diuretics include bumetanide, ethacrynate, furosemide, and torsemide.

Potassium-sparing diuretics are the least potent but still adequate for reducing the reabsorption of sodium. They are often prescribed for people at risk of having low potassium levels. Common potassium-sparing diuretics include amiloride, spironolactone, triamterene, and eplerenone.

Alpha-blockers

Alpha-blockers³ work by preventing norepinephrine from tightening muscles in the walls of smaller veins and arteries. This keeps blood vessels open and relaxed, which lowers the blood pressure and improves circulation. Alpha-blockers also relax other muscles in the body, which can be helpful for improving urine flow in people with prostate problems. Examples include doxazosin, terazosin, and prazosin.

Angiotensin II receptor blockers (ARBs)

Angiotensin II hormone binds with receptors on blood vessels, causing them to constrict and increase blood pressure. ARBs work by blocking that hormone, preventing it from causing muscles to tighten, leaving the blood vessel walls more relaxed, and lowering blood pressure. Examples include candesartan, irbesartan, telmisartan, and eprosartan.

Calcium channel blockers

Sometimes known as calcium antagonists or CCBs, calcium channel blockers prevent calcium from getting into certain muscle cells in the blood vessels and heart.

Some CCBs slow down the heart rate and make the heart ease up on how hard it works to pump blood to the rest of the body. Other CCBs prevent blood vessels from constricting.

Either way, these medications give blood more room to move freely, and that lowers blood pressure.

They are not usually prescribed for people with irregular heart rhythms or constipation issues. Examples of CCBs include bepridil, verapamil, isradipine, nisoldipine, and felodipine.

Peripheral adrenergic blockers

These antihypertensive medications prevent neurotransmitter messengers from telling the smooth muscles in blood vessels to tighten. They are rarely prescribed unless other drugs don't work. Examples include guanadrel, reserpine, and guanethidine monosulfate.

Beta-blockers

Also known as beta-adrenergic blocking agents, beta-blockers keep epinephrine (adrenaline) and norepinephrine from binding to the beta receptors on the nerves.

There are three types of beta receptors that control different functions based on their location in the body. Beta-1 receptors are located in the heart, kidney, and eyes. Beta-2 receptors are found in the blood vessels, gastrointestinal tract, skeletal muscle, lungs, and uterus. Beta-3 receptors are located in fat cells.

Beta-blockers primarily block beta-1 and beta-2 receptors. By doing so, they reduce the heart rate and dilate blood vessels, lowering the blood pressure. Common beta-blockers include acebutolol, betaxolol, metoprolol, and atenolol.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors prevent the body from producing angiotensin II, a hormone that tells blood vessels to constrict. This allows the blood vessels to stay open and the blood to flow more freely. Common ACE inhibitors include fosinopril, moexipril, trandolapril, benazepril, and perindopril.

Direct renin inhibitors

These work the same way as ARBs and ACE inhibitors, ensuring that the blood vessels don't tighten up. However, they primarily target the enzyme renin and keep it from triggering reactions that lead to blood vessel constriction.

Central agonists

These medications block the chemical messengers that normally send signals to speed up the heart rate and tighten the blood vessels. Central agonists are sometimes referred to as central alpha agonists, central-acting agents, and central adrenergic inhibitors. They are less frequently prescribed due to their side effects⁴, such as fatigue, sleepiness, and dry mouth. Examples include guanfacine, guanabenz, clonidine, and methyldopa.

Vasodilators

Vasodilators relax the muscles in the blood vessel walls, allowing them to open and blood to flow more easily. They are also prescribed to people with congestive heart failure, preeclampsia, or cardiac pain, among other conditions. Common vasodilator medications include minoxidil and hydralazine.

You can probably appreciate the common thread here — all of these medications work to change something in the body that leads to more relaxed blood vessels, allowing blood to move more freely and lowering blood pressure.

When does someone need to take medication for high blood pressure?

Some people may not want to take high blood pressure medications when they don't have any symptoms, or they just don’t like to take daily medicine. Others feel that the medication doesn't help because their blood pressure fluctuates throughout the day, even though that doesn’t mean they aren’t hypertensive. Whatever your beliefs, deciding not to treat high blood pressure is a huge mistake.

Blood pressure control with medications can greatly reduce the risk of stroke, cardiovascular disease, and heart attack. However, whether you need to start medication right away or not mainly depends on the severity of hypertension and your general health.

The first step toward determining whether you need medication is to look at your numbers.

Blood pressure is usually measured in millimeters of mercury (Hg) and indicated with a top and bottom number, e.g., 125/85mm Hg. The top number indicates the pressure when your heart squeezes, while the lower number reflects the pressure when your heart relaxes. The normal adult blood pressure is under 120/80mm Hg. If either of those numbers is higher, it means there is extra pressure on the arteries.

Where do your numbers fall on the blood pressure range, and what do they mean?

120-129 and < 80mm Hg or less: you probably don't need blood pressure medication

Your blood pressure is mildly elevated, but it's not yet full-blown hypertension. The doctor will most likely recommend lifestyle changes and not prescribe any drugs unless you have another condition like kidney disease or cardiovascular problems. However, if you choose to ignore the fact that it’s elevated and do nothing, things may get worse. Consider cutting out cigarettes, reducing alcohol use, eating a healthy diet lower in fat and salt, exercising more, and losing excess weight.

130-139mm Hg systolic or 80-89mm Hg diastolic: you might need medication

These numbers qualify as stage 1 hypertension, and some action is needed. Medical advice will probably be to try lifestyle changes before medication is prescribed, although many people have a difficult time making these changes and end up on medication.

It's worth noting that treatment guidelines are different for various age groups. For instance, people aged 60 years and older should start treatment immediately if their blood pressure goes above 130/80mm Hg.

140/90mm Hg or higher: you probably need medication

This level qualifies as stage 2 hypertension, and medication is much more likely to be prescribed to get it under control. You'll also need to make lifestyle changes.

Your numbers don't tell the whole story

There are other considerations when your physician is deciding whether you need to start taking blood pressure medications. For starters, one reading isn't enough to diagnose high blood pressure. Your measurements will probably be tracked over several visits to be sure.

Other questions that will come into play include:

Do you have other health conditions?

Your doctor will recommend hypertension medicine more readily if you have high cholesterol, heart disease, or diabetes because they increase your risk of complications such as stroke or heart attack.

How old are you?

The risks of high blood pressure increase with age, and it is more important to get it under control without wasting time.

Are there other reasons you are at risk of heart attack or stroke?

Men, women after menopause, people who are overweight, smoke, overuse alcohol, have a sedentary lifestyle, or have a family history of hypertension are at an increased risk of developing heart disease. 

How will your doctor determine which high blood pressure medication is right for you?

The type of high blood pressure medication prescribed to you primarily depends on your specific case — a combination of your risk factors and the severity of your high blood pressure.

ACE inhibitors and angiotensin receptor blockers are often one of the first-line treatments for high blood pressure. ACE inhibitors tend to be prescribed more often because they have relatively few side effects and have been studied more extensively. ACE inhibitors are ideal for people who also have diabetes, kidney disease, heart failure, or a history of stroke or heart attack.

ARBs are often prescribed to people who might be candidates for ACE inhibitors but can't take them due to excessive coughing (a well-known side effect). It's worth noting that taking ACE inhibitors and ARBs simultaneously isn't recommended as the combination could lead to kidney failure.

Your doctor may recommend thiazide diuretics as a first-choice medication, alone or alongside other drugs, depending on the specifics of your condition. Diuretics are a good choice for people with diseases that involve high blood volume or swelling, such as heart or kidney failure or other conditions that cause potassium loss.

Calcium channel blockers are ideal for people with angina, heart rhythm abnormalities, or migraines.

What are the possible side effects of high blood pressure medications?

People experiencing unwanted side effects often don’t want to continue taking them long-term—particularly when they don’t have any symptoms when they’re off the medicine. Some of the common side effects of high blood pressure medications include:

• Diarrhea or constipation

• Erectile dysfunction

• Feeling tired, weak, or lacking energy

• Skin rash

• Persistent dry cough

• Dizziness and lightheadedness

• Feeling nervous

• Headache

• Nausea and vomiting

• Unintentional weight loss or gain

Diuretics may not be suitable for people with certain conditions like diabetes, kidney problems, gout, menstrual problems, pancreatitis, or lupus. They are also not ideal for people at risk of dehydration or low potassium levels. Other blood pressure medicines, such as cyclosporine, digitalis, digoxin, and certain antidepressants can interact with diuretics and cause adverse side effects.

Some drugs like alcohol, cough and cold medications, other high blood pressure medicines, antidepressants, and allergy shots impact the effectiveness of beta-blockers. Beta-blockers may not be appropriate for people with kidney problems, erectile dysfunction, diabetes, asthma and COPD, slow heart rate, food allergies, or hyperthyroidism.

Medications that interact with ACE inhibitors include drugs and supplements containing potassium, other high blood pressure drugs, or diuretics. ACE inhibitors may not be prescribed for certain people, namely those with kidney failure, a previous allergic reaction while taking them, or who are pregnant.

Certain medications can increase or reduce the side effects of angiotensin II receptor blockers, including diuretics, other blood pressure meds, over-the-counter drugs for coughs and allergies, medications and supplements that contain potassium, and some heart medicines.

ARBs may not be suitable for people who had a bad reaction to ACE inhibitors or have any of the following conditions:

• Dehydration

• Severe congestive heart failure

• Diabetes

• Kidney disease

Substances like alcohol, certain other blood pressure medications, and barbiturates or benzodiazepines can cause a dangerous dip in blood pressure if taken alongside alpha-blockers. Alpha-blockers can also worsen the symptoms of narcolepsy, heart failure, and angina.

You shouldn't take central agonists alongside alcohol, sleeping pills, or antidepressants, as this can cause the blood pressure to drop dangerously low. Central agonists can also worsen the symptoms of angina, depression, heart disease, kidney or liver disease, and Parkinson’s disease.

Peripheral adrenergic inhibitors may interact with asthma medications, alcohol, other blood pressure medications, or diuretics. They may not be suitable for people with vascular disease, peptic ulcers, fluid retention, depression, or congestive heart failure.

High blood pressure medication during pregnancy

Hypertension during pregnancy can cause problems for you and your baby. Some women develop high blood pressure before they become pregnant, while others develop the condition for the first time during pregnancy. Preeclampsia is a serious blood pressure disorder that can impact pregnancy and childbirth.

High blood pressure during pregnancy poses certain risks, including:

• Reduced blood flow to the baby

• Placental abruption (where the placenta separates from the inner uterine wall)

• Intrauterine growth restriction (slowing the baby’s growth)

• Injury to other body organs

• Premature delivery to prevent life-threatening complications

• Increased risk of future cardiovascular disease

Some high blood pressure medications also present a risk to pregnant women and their unborn children. Certain drugs will be prescribed for specific trimesters, while others are best avoided throughout the pregnancy. Medical experts often avoid prescribing ACE inhibitors, renin inhibitors, and angiotensin II receptor blockers during pregnancy.

If you are pregnant or planning on it, be sure to talk to your healthcare professional before taking any high blood pressure medications. That said, treating high blood pressure during pregnancy is crucial. Your doctor will determine the safest medication and prescribe it at the appropriate dose, but it’s up to you to take it regularly to achieve the best blood pressure control.

You can also take certain steps to reduce the risk of high blood pressure complications for you and your baby. Start by keeping your prenatal appointments throughout the pregnancy. In addition to taking your medication as prescribed, you should also stay active, eat a healthy diet, manage stress, and follow any other instructions you and your medical practitioner have discussed.

High blood pressure medications for children

Your child’s pediatrician will first get a few blood pressure readings to confirm hypertension is present. They will very often do a workup to rule out any underlying condition that may be causing high blood pressure. If your child is diagnosed with slightly or moderately high pressure and no cause is found, the next step would be to recommend a trial of lifestyle changes. Typically, they will only prescribe medication if lifestyle changes don't work.

They will likely recommend medication if your child is diagnosed with stage II hypertension⁵. Medications might include angiotensin II receptor blockers, calcium channel blockers, beta-blockers, diuretics, and/or ACE inhibitors.

In any case, it is recommended to change some unhealthy habits that are known to contribute to high blood pressure in children and focus on implementing healthy ones. Some lifestyle changes that can improve blood pressure and increase the effectiveness of antihypertensive medications include:

• Controlling your child's weight 

• Cutting the amount of salt in their diet: limited to 1,200mg per day for 2- to 3-year-olds and 1,500mg per day for older children

• Limit processed foods and eating at fast food places as the foods are high in fat, calories, and sodium

• Eating a healthy diet that's high in fruits, vegetables, whole grains, fiber, lean proteins, and low-fat dairy products from an early age

• Encouraging physical activity and limiting screen time

• Learning to manage stress and promoting a calm home environment

• Giving your child lots of support and getting the whole family involved

There is minimal information on the effects of antihypertensive medication on the growth and development of children. However, the risks of complications from high blood pressure are paramount, and most medications are safe for children.

Once your child’s blood pressure has been controlled with medication, their pediatrician will determine how often they will need blood pressure monitoring going forward. It's best to never change the dose or stop the medicine altogether without first getting medical advice.

Do you have to take blood pressure medications forever?

High blood pressure is not a condition you treat once and then ignore. For those who are overweight or obese, losing just five pounds can lower their blood pressure. The blood pressure will keep dropping as excess weight is shed and, with time, medical tests may demonstrate that it’s safe to reduce or sometimes even stop taking medication. This isn't a decision you should make on your own as it can lead to unprecedented health consequences.

Even if you get to stop taking high blood pressure medication, you must maintain healthy habits throughout your life like:

• Eating a healthy diet high in fruits, vegetables, fiber, and whole grains and low in salt, sugar, and fats

• Getting at least 30 minutes of physical activity each day

• Managing stress and anxiety

• Managing your weight and keeping it within the normal range

• Avoiding or limiting alcohol and quitting smoking

• Getting regular health checkups to monitor cholesterol, blood sugar, and blood pressure

When should you see a doctor for high blood pressure?

More often than not, hypertension doesn't cause visible symptoms. So how do you know when you need to see a medical professional? You should get your regular checkups, where your doctor will track your blood pressure readings. And if there are any concerns, they will provide appropriate recommendations to bring your blood pressure down.

That said, be sure to seek immediate medical care if:

• You have extremely high blood pressure readings — no matter how you are feeling

• You have symptoms like blurry vision and severe headache

• You are dizzy, lightheaded, or feel like you might faint

You'll also want to visit your doctor if you think your blood pressure medications are causing side effects. The same is true if your blood pressure numbers get higher than your recommended safe level at least twice.

The lowdown

If left unmanaged, high blood pressure is a serious condition that damages blood vessels and organs and leads to serious health complications. Lifestyle changes and prescribed medications can improve your quality of life while reducing the risk of kidney disease, heart disease, stroke, and other complications of long-standing hypertension.

It might take a while for your physician to determine which are the best medications to control your blood pressure, and you may need more than one. Be sure to disclose any over-the-counter drugs or other prescriptions you’re taking, as some of them can change the effectiveness of high blood pressure medications.

Remember to take medications exactly as prescribed, and don't forget, skip, or reduce your dose. Doing so can cause your blood pressure to skyrocket and put you at risk of complications.

Last, but not least, expect to take high blood pressure medication for the rest of your life. The doctor may reduce your dosage if you make sufficient lifestyle changes to show consistent improvement in your numbers, but many people require medications to maintain adequate control of their blood pressure. Choosing a healthy lifestyle is best to keep all of your body systems functioning at their best throughout your life.