Regular checkups can help you reach your blood pressure goal.
Uncontrolled high blood pressure, or hypertension, is a leading risk factor for heart disease, kidney failure and stroke. Quitting smoking, staying active and avoiding foods high in sodium are essential for keeping blood pressure under control. Nevertheless, many people still need medications to help treat high blood pressure. A number of high blood pressure medications are available and more than one may be required to achieve optimal blood pressure control.
Diuretic medications, sometimes called water pills, help lower blood pressure by removing excess salt and water from the body. Thiazide diuretics, including hydrochlorothiazide (Microzide) and chlorthalidone (Thalitone), are often among the first drugs selected for blood pressure control. These medications have been used for decades and are associated with relatively few side effects. However, they can cause electrolyte imbalances, such as low potassium levels. Routine blood work to monitor electrolytes can prevent complications. Diuretics are used cautiously in people with liver or kidney disease and in people with allergies to sulfa-containing drugs.
Calcium Channel Blockers
Calcium channel blockers are medications that relax the arteries, a process which decreases blood pressure. Amlodpine (Norvasc) and nifedipine (Adalat CC, Nifedical XL) are calcium channel blockers commonly used for high blood pressure. Other options include diltiazem (Cardizem CD, Cartia) and verapamil (Isoptin SR, Covera-HS). These calcium channel blockers also provide heart rate control for people with high blood pressure who also have atrial fibrillation, a common heart rhythm abnormality. Diltiazem and verapamil may not be the best choice for people with heart failure, however, as they can make heart failure symptoms worse. Additionally, amlodpine can cause swelling in the legs, which may require a dose adjustment.
Angiotensin-Converting Enzyme Inhibitors
Newer blood pressure medications known as angiotensin-converting enzyme inhibitors (ACEIs) block the action of renin, a hormone that increases blood pressure. Lisinopril (Zestril, Prinivil), enalapril (Vasotec) and ramipril (Altace) are often prescribed. Many ACEIs are also available in combination form with diuretics and calcium channel blockers, including lisinopril/hydrochlorothiazide (Zestoretic) and enalapril/hydrochlorothiazide (Vaseretic). ACEIs are especially useful for blood pressure control in people with diabetes, as they can help prevent kidney disease. Women who are pregnant should not use ACEIs due to known risks to the developing fetus.
Angiotensin Receptor Blockers
Angiotensin receptor blockers, or ARBs, also treat high blood pressure by interfering with the hormone renin. Valsartan (Diovan), losartan (Cozaar) and olmesartan (Benicar) are frequently used. Combination medications include valsartan/amlodipine (Exforge) and losartan/hydrochlorothiazide (Hyzaar). ARBs protect against kidney disease. They are sometimes used to control blood pressure in people who experience side effects from ACEIs. ARBs should not be taken during pregnancy due to known risks to the developing fetus.
Beta blockers have been used for many years to treat heart disease, abnormal heart rhythms and high blood pressure. As newer therapies have been developed, beta blockers are rarely used alone to treat hypertension. However, they can still be helpful in achieving blood pressure control. Beta blockers commonly used to treat high blood pressure include labetalol (Trandate), atenolol (Tenormin) and bisoprolol (Zebeta). Combinations of beta blockers and diuretics, such as tenolol/chlorthalidone (Tenoretic) and bisoprol/hydrochlorothiazide (Ziac), may also be prescribed. Use of beta blockers with the calcium channel blockers diltiazem and verapamil is generally avoided since this can lead to a dangerously slow heart rate.