High blood pressure is very common. It often does not cause symptoms; however, high blood pressure can increase the risk of stroke, heart attack, and heart failure. Therefore, it is important to treat high blood pressure. People with high blood pressure should make changes in their lifestyle to help reduce blood pressure. However, if such changes do not sufficiently reduce blood pressure, medication treatment is needed.
Medications that are used in the treatment of high blood pressure are called antihypertensives. With the wide variety of antihypertensives available, high blood pressure can be controlled in almost anyone, but treatment has to be tailored to the individual. (See also High Blood Pressure.) Treatment is most effective when the person and doctor communicate well and collaborate on the treatment program.
Different types of antihypertensives reduce blood pressure by different mechanisms, so many different treatment strategies are possible. For some people, doctors use a stepped approach to treatment with medications: They start with one type of antihypertensive and add others as necessary. For other people, doctors find a sequential approach is preferable: They prescribe one antihypertensive, and if it is ineffective, they stop it and prescribe another type. For people with blood pressure at or above 140/90 mm Hg, usually two medications are started at the same time. In choosing an antihypertensive, doctors consider such factors as
The person's age, sex, and sometimes ethnicity
The severity of high blood pressure
The presence of other conditions, such as diabetes or high blood cholesterol levels
Potential side effects, which vary depending on the medication
The costs of the medications and of tests needed to check for certain side effects
Most people ultimately require two or more medications to reach their blood pressure goal.
Most people tolerate their prescribed antihypertensive medications without problems. But any antihypertensive medication can cause side effects. So if side effects develop, a person should tell the doctor, who can adjust the dose or substitute another medication. Usually, an antihypertensive medication must be taken indefinitely to control blood pressure.
Adrenergic blockers
Adrenergic blockers include alpha-blockers, beta-blockers, alpha-beta blockers, and peripherally acting adrenergic blockers. These medications block the effects of the sympathetic division, the part of the autonomic nervous system that can rapidly respond to stress by increasing blood pressure.
Beta-blockers are no longer considered first-line medications for the treatment of hypertension. They are sometimes useful people who have had a heart attack, have a rapid heart rate, angina pectoris (chest pain due to inadequate blood supply to the heart muscle), or migraine headaches.
Alpha-blockers are also no longer used as the main therapy for hypertension because they do not decrease the risk of death. Peripherally acting adrenergic blockers are usually only used if a third or fourth type of medication is needed to control blood pressure.
Angiotensin-converting enzyme inhibitors
Angiotensin-converting enzyme (ACE) inhibitors lower blood pressure in part by dilating arterioles. They dilate arterioles by preventing the formation of angiotensin II, a chemical produced in the body that causes arterioles to constrict. Specifically, these inhibitors block the action of angiotensin-converting enzyme, which converts angiotensin I to angiotensin II (see figure Regulating Blood Pressure). These medications are particularly useful for people with coronary artery disease or heart failure, young people, people with protein in their urine because of chronic kidney disease or diabetic kidney disease, and men who develop sexual dysfunction as a side effect of another antihypertensive medication.
Angiotensin II receptor blockers
Angiotensin II receptor blockers (ARBs) lower blood pressure by a mechanism similar to the one used by angiotensin-converting enzyme inhibitors: They directly block the action of angiotensin II, which causes arterioles to constrict. Because the mechanism is more direct, angiotensin II receptor blockers may cause fewer side effects than angiotensin-converting enzyme inhibitors.
Calcium channel blockers
Calcium channel blockers cause arterioles to dilate by a completely different mechanism. They are particularly useful for people of African ancestry and older people. Calcium channel blockers are also useful for people who have angina pectoris, certain types of rapid heart rate, or migraine headaches. Calcium channel blockers may be short-acting or long-acting. Short-acting calcium channel blockers are not used to treat high blood pressure. Reports suggest that people using short-acting calcium channel blockers may have an increased risk of death due to heart attack, but no reports suggest such effects for long-acting calcium channel blockers.
Centrally acting alpha agonists
Centrally acting alpha-agonists lower blood pressure through a mechanism that somewhat resembles that of adrenergic blockers. By stimulating certain receptors in the brain stem, these agonists inhibit the effects of the sympathetic division of the nervous system. These medications are rarely used now.
Direct vasodilators
Direct vasodilators dilate blood vessels by another mechanism. A medication of this type is almost never used alone; rather, it is added as a second medication when another medication alone does not lower blood pressure sufficiently.
Type | Examples | Some Side Effects |
|---|---|---|
Adrenergic blockers | ||
Alpha-blockers | Fainting (syncope) with the first dose, awareness of rapid heartbeats (palpitations), dizziness, low blood pressure when the person stands (orthostatic hypotension), and fluid retention (edema) | |
Beta-blockers |
| With some beta-blockers, an increased triglyceride level |
Alpha-beta blockers | Low blood pressure when the person stands and spasm of the airways | |
Angiotensin-converting enzyme (ACE) inhibitors | ||
— | Cough (in up to 20% of people), low blood pressure, an increased potassium level, rash, angioedema (allergic swelling that affects the face, lips, and windpipe and may interfere with breathing), and, in pregnant women, serious injury to the fetus | |
Angiotensin II receptor blockers (ARBs) | ||
— |
| Dizziness, an increased potassium level, angioedema (rarer than with ACE inhibitors), and, in pregnant women, serious injury to the fetus |
Calcium channel blockers | ||
Dihydropyridines | Dizziness, fluid retention in the ankles, flushing, headache, heartburn, enlarged gums, and an abnormally fast heart rate (tachycardia) | |
Nondihydropyridines | Headache, dizziness, flushing, fluid retention, problems in the heart's electrical conduction system (including heart block), an abnormally slow heart rate (bradycardia), heart failure, and enlarged gums | |
Centrally acting alpha-agonists | ||
— |
| |
Direct vasodilators | ||
— | Headache, an abnormally fast heart rate (tachycardia), and fluid retention | |
Diuretics | ||
Loop diuretics | Decreased levels of potassium and magnesium, temporarily increased levels of blood sugar and cholesterol, an increased level of uric acid, sexual dysfunction in men, and digestive upset | |
Potassium-sparing diuretics | With all, a high potassium level and digestive upset | |
Thiazides and thiazide-like diuretics |
| Decreased levels of potassium and magnesium, increased levels of calcium and uric acid, sexual dysfunction in men, and digestive upset |
Diuretics
Diuretics are particularly useful for people of African ancestry, older people, people with obesity, and people with heart failure or chronic kidney disease.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
American Heart Association: High blood pressure: Comprehensive resource to help people understand the causes of high blood pressure and manage the lifestyle changes required for treatment
