Blood Pressure Medications

Using medications to treat high blood pressure or hypertension (HTN) is based on a large number of rigorous scientific studies. These studies have shown treating blood pressure to the guidelines established by the Joint National Committee (JNC 8) prevents heart attacks and strokes as well as protects other organs from damage (examples include the kidneys and eyes). However, starting medications for the rest of their lives is not done lightly. A patient must first have a clearly established diagnosis of hypertension (high blood pressure).

To determine if a person has hypertension, their blood pressure measurement must be 140/90 mm Hg or higher on two or more separate occasions to meet the criteria for a diagnosis of HTN. In addition, the subtype of high blood pressure must also be established. There are two subclassifications of HTN. Primary hypertension is the most common and is treated with lifestyle modifications and medications as needed per the JNC 8 guidelines. Secondary hypertension is caused by other disease processes that can be identified and treated. Blood pressure usually returns to normal levels once the other condition is corrected. In addition to medications, the JNC 8 guidelines emphasize the importance of weight control, exercise, and a healthy diet. To prevent damage to kidneys, eyes, and other organs, medication along with lifestyle changes have been shown to be more effective for people with diabetes or chronic kidney disease than lifestyle changes alone.

Drug Therapies

There are several classes of anti-hypertensive medications available that work in different ways to bring blood pressure under control. Diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), and angiotensin receptor blockers (ARBs) are appropriate medications to start with initially. Diuretics (example: hydrocholorothiazide) lower the blood pressure by decreasing the amount of fluid in your blood. This is accomplished by the kidney which flushes water out of the body along with sodium. Diuretics are used more commonly in patients that are black, elderly, obese or smoke than ACE inhibitors and beta-blockers because diuretics are more effective for those patient populations . Diuretics are also helpful in preventing the loss of calcium in older women at risk for osteoporosis.

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin-converting enzyme (ACE) inhibitors, like diuretics, are frequently used as the first drug of choice for mild to moderate hypertension. They stimulate the production of chemicals that cause blood vessels to dilate, thereby lowering the blood pressure. Swelling in the lower legs and a dry cough can be seen as side effects of these medications. They are even more effective in lowering blood pressure when used in combination with other medications such as diuretics and calcium channel blockers.

Angiotensin receptor blockers (ARBs)

A similar class of medications, the angiotensin receptor blockers (ARBs) have been shown to improve the quality of life, decrease hospitalizations, and even decrease the risk of death in hypertensive patients who also have heart failure or kidney damage due to diabetes. A concerning side effect is ARBs can cause hypotension (low blood pressure) in patients who have narrow kidney arteries.

Beta blockers 

Beta blockers (ex. metoprolol) are effective in decreasing the heart rate and prevents the heart from working too hard. Beta blockers have been proven helpful in treating patients with angina, previous heart attacks, congestive heart failure and some forms of anxiety. Beta blockers are not as effective in preventing strokes and enlargement of the left side of the heart as other blood pressure medications. Betablockers can also cause problems with erectile dysfunction (ED) and can hide some problems in patients with diabetes. That is why some providers that do not use them as initial treatment for HTN.

Calcium channel blockers (CCBs)

Calcium channel blockers (CCBs), act by causing blood vessels to dilate in the extremities. They cause less fluid retention and less racing of the heart than other blood pressure medications that work by dilating blood vessels. They work well in all populations and age groups and are preferable to beta blockers and ACE inhibitors in blacks and older adults. They also protect against stroke.

Central-acting alpha-blockers 

Some drugs work on the brain to stimulate the brain to lower the blood pressure. Another name for them are central-acting antihypertensive medications. An example is clonidine. These are used only when the other classes fail because of rebound hypertension if the patient forgets to take the medication.

Treatment with blood pressure medications

Patients generally need less medication if they maintain a healthy weight, exercise regularly, and eat a healthy diet, but this is not always the case. It is not unusual for patients to need two to three medications to keep their blood pressure at recommended levels. Fortunately, there are many combination blood pressure pills. By using these combination pills, there is less work to taking mediations as directed and also less cost due to multiple copays.


As with all medications, there can be serious side effects to the each of the different classes of blood pressure medications. If you are planning to or taking blood pressure medication, make sure you take the medication the way it was prescribed. Understand the types of side-effects that are common with your medications and contact your provider if you develop any of them. However, remember when starting new medications, it is not uncommon to experience changes that are the result of your body getting used to the drug rather than an allergic reaction or side effect. Anytime you have a question or concern, contact your medical provider or pharmacist and, as always, keep these and all medications in a safe, dry, and dark place to prevent the drugs from being misused or losing potency by exposure to light.




The American Heart Association recommends that you discuss all of your medications with your healthcare provider:

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Reference:

James, P. A. (2014). 2014 Guidelines for the Management of High Blood Pressure in Adults. JAMA, 311(5), 507-520.