Your High Blood Pressure Prescription, Decoded

Understanding your medication options can help you stick to your treatment plan.

Medically reviewed in September 2021

The Centers for Disease Control and Prevention estimates that almost half of American adults—a whopping 108 million people—have high blood pressure, and that only about one-quarter of those with the condition have it under control.

That’s a problem because high blood pressure can lead to a host of other serious heart issues, like heart attack, stroke, aneurysm, and heart failure—all of which can be fatal. In addition to these cardiac problems, high blood pressure is also a cause of or contributor to kidney problems, vision loss, metabolic syndrome, cognitive problems, and dementia.

The good news is that healthcare providers (HCPs) know a lot about what works to get high blood pressure under control. Sometimes making lifestyle changes for hypertension—like tweaking your diet, getting more active, and keeping weight under control—is enough. For others, medications can help.

Drugs for treating high blood pressure
There are a few different types of medications used to treat high blood pressure. Your prescription will depend on things like your blood pressure measurements, other medical problems, and your health history.

Diuretics: Sometimes called “water pills,” diuretics help lower the amount of sodium and water in the body, which reduces the amount of fluid in the blood. Lowering the volume of blood in your vessels decreases blood pressure. Your HCP may prescribe a diuretic alone or in combination with another blood pressure medication. In some cases, your HCP may prescribe a potassium supplement if your blood potassium level drops too low on a diuretic.

Thiazide diuretics (including chlorothiazide, hydrochlorothiazide, and chlorthalidone) are the main type used. Sometimes loop diuretics (such as bumetanide and ethacrynic acid) and potassium-sparing diuretics (such as spironolactone) are prescribed, as well.

Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors work by blocking the formation of a chemical the body makes to narrow the blood vessels (angiotensin II hormone). This, in turn, relaxes blood vessels. Some ACE inhibitors include lisinopril, benazepril, and captopril.

Angiotensin II receptor blockers (ARBs): ARBs employ a mechanism similar to ACE inhibitors. Instead of blocking the production of angiotensin II hormone, however, they stop the chemical from binding with receptors in the blood vessels. Like ACE inhibitors, ARBs prevent blood vessels from narrowing, thereby decreasing blood pressure overall. Specific ARBs include candesartan, losartan, and valsartan.

Angiotensin II receptor blocker neprilysin inhibitors (ARNIs): Sacubitril/valsartan is the first drug in this newer class of medications that can lower blood pressure for some people with heart failure. ARNIs combine the ARB drug valsartan with another medication called sacubitril, which also acts to relax blood vessels.

Calcium channel blockers: These drugs—which include amlodipine and diltiazem—block calcium from entering the muscle cells of the heart and blood vessels, thus allowing blood vessels to relax and blood pressure to go down.

Other drugs that may help control high blood pressure
Sometimes additional drugs are used to help control hypertension, including:

  • Alpha blockers, to reduce nerve impulses to blood vessels to lessen the natural narrowing process
  • Alpha-beta blockers, which have the same function as alpha blockers, while also slowing the heartbeat to reduce how much blood gets pumped through vessels
  • Beta blockers, to reduce the workload on the heart and open up blood vessels, which makes the heart beat slower and with less force
  • Aldosterone antagonists, which block the action of a chemical that causes the body to retain salt and fluid
  • Renin inhibitors, which slow down the production of renin, an enzyme produced by the kidneys that increases blood pressure
  • Vasodilators, which stop the muscles in the walls of your arteries from tightening
  • Central-acting agents, which turn down signals from the brain to your nervous system that increase heart rate and narrow blood vessels
  • Sodium glucose co-transporter (SGLT2) inhibitors, which are used by people with type 2 diabetes to reduce blood sugar and are associated with weight loss and lower blood pressure

Side effects to consider
Like any medications, those used to treat hypertension can cause side effects. It’s important to remember, though, that you shouldn’t stop taking your medications for high blood pressure without checking with your HCP. The appearance of side effects might lead your HCP to adjust the dose or type of drug you take.

Some of the more common side effects include:

  • Weakness, fatigue, or drowsiness
  • Erectile dysfunction
  • Trouble sleeping
  • Slow or fast heartbeat
  • Skin rash
  • Feeling thirsty
  • Cough
  • Muscle cramps
  • Headache, dizziness, or light-headedness
  • Constipation or diarrhea
  • Frequent urination (for diuretics)

Staying with your treatment plan
Your HCP will come up with a treatment plan to help you manage your high blood pressure based on your health, lifestyle, and personal preferences. That plan may include lifestyle changes, medications, or a combination of the two. What’s most important is that you follow your treatment plan—and let your HCP know about any problems that come up so you can work together to find the best solution for you.

Sources:

Centers for Disease Control and Prevention. “High Blood Pressure.” October 22, 2020. Accessed April 19, 2021.
Mayo Clinic. “High blood pressure (hypertension).” January 16, 2021. Accessed April 19, 2021.
American Heart Association. “Types of Blood Pressure Medications.” October 31, 2017. Accessed April 19, 2021.
Harvard Health Publishing. “Adding a diuretic to your blood pressure drug.” May 2015. Accessed April 19, 2021.
National Heart, Lung, and Blood Institute. “High Blood Pressure.” May 8, 2020. Accessed April 19, 2021.
PA James, S Oparil, et al. “2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8).” JAMA. 2014;311(5):507–520.
UpToDate.com. “Choice of drug therapy in primary (essential) hypertension.” March 2021. Accessed April 19, 2021.
Blood Pressure UK. “Medications for high blood pressure.” 2021. Accessed April 19, 2021.
Cochrane. “Alpha blockers have a modest BP lowering effect.” August 15, 2012. Accessed April 19, 2021.
American Heart Association. “What is High Blood Pressure Medicine?” 2020. Accessed April 19, 2021.
Sacubitril/Valsartan. Treasure Island (FL): StatPearls Publishing; 2021. Accessed September 14, 2021.
HeartFailureMatters.org. “Angiotensin Receptor-Neprilysin Inhibigor (ARNI) – Sacubitril/Valsartan.” 2021. Accessed September 14, 2021.
Heart Foundation NZ. “Angiotensin receptor neprilysin inhibitors (ARNIs).” 2021. Accessed September 14, 2021.
U.S. Food & Drug Administration. “Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors.” August 20, 2018. Accessed September 14, 2021.
K Kario, K Okada, et al. “Twenty-Four-Hour Blood Pressure–Lowering Effect of a Sodium-Glucose Cotransporter 2 Inhibitor in Patients With Diabetes and Uncontrolled Nocturnal Hypertension.” Circulation. 2019;139:2089–2097.
Johns Hopkins Patient Guide to Diabetes. “SGLT2 Inhibitors.” 2021. Accessed September 14, 2021.

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