High blood pressure, also known as hypertension, is a serious medical condition that can lead to heart disease, stroke, and other health problems. Nearly half of American adults have high blood pressure, so it’s no surprise that medications to lower blood pressure are among the most commonly prescribed drugs.
Quick answers
The most common medications prescribed for high blood pressure are:
- Diuretics
- ACE inhibitors
- Angiotensin II receptor blockers (ARBs)
- Calcium channel blockers
- Beta blockers
These drugs help lower blood pressure through different mechanisms, such as decreasing fluid volume, relaxing blood vessels, and slowing heart rate. They may be prescribed alone or in combination. Lifestyle changes like diet, exercise, and stress management are also critical for controlling high blood pressure.
What causes high blood pressure?
Blood pressure is the force of blood pushing against the walls of the arteries. It is recorded as two numbers—systolic pressure (when the heart beats) over diastolic pressure (when the heart relaxes between beats). Normal blood pressure is less than 120/80 mmHg, while high blood pressure is 130/80 mmHg or above.
In most cases, the cause of high blood pressure is unknown. This is called primary or essential hypertension. It tends to develop gradually over many years and is influenced by genetics, age, obesity, sedentary lifestyle, diet, and other factors. Secondary hypertension has an identifiable cause like chronic kidney disease, tumors, or birth control pills.
Risk factors for high blood pressure
Some of the top risk factors for developing high blood pressure include:
- Age: The risk increases with age, affecting more than half of people over 60.
- Race: High blood pressure is more common among African Americans.
- Family history: Having close blood relatives with hypertension increases your risk.
- Obesity: Being overweight puts extra strain on the heart.
- Sodium intake: Eating foods high in salt can cause fluid retention.
- Alcohol and tobacco: Heavy use of these substances strains the heart.
- Stress: High levels of stress hormones can lead to constriction of blood vessels.
- Sedentary lifestyle: Lack of exercise causes arteries to harden.
- Chronic conditions: Diabetes, kidney disease, and sleep apnea increase risk.
Some of these risk factors are modifiable through lifestyle changes and treatment of underlying conditions. Others like age, race, and family history cannot be changed.
Complications of high blood pressure
If left uncontrolled, persistently high blood pressure can damage the body over time and lead to dangerous health complications including:
- Heart attack and heart failure
- Stroke
- Kidney disease and kidney failure
- Vision loss
- Dementia
- Peripheral artery disease
- Pulmonary edema
- Aneurysms
That’s why it’s so important to lower elevated blood pressure through a combination of medication, diet, exercise, and other lifestyle changes.
Guidelines for treating high blood pressure
The most recent hypertension guidelines were published in 2017 by the American College of Cardiology and American Heart Association. Some key points include:
- Blood pressure below 120/80 mmHg is considered normal.
- Readings of 130-139/80-89 mmHg should be treated with lifestyle changes.
- Stage 1 hypertension is 140-159/90-99 mmHg and should be treated with medication.
- Stage 2 hypertension is 160/100 mmHg or higher and requires urgent treatment.
- For patients over 60, the goal is to get below 150/90 mmHg.
- Diabetes or kidney disease patients should aim for below 130/80 mmHg.
Doctors take into account other risk factors like age, diabetes status, and cardiovascular disease history when determining blood pressure treatment goals and medications.
Types of medications for high blood pressure
There are many different classes of medications used to treat high blood pressure. They lower blood pressure through various mechanisms of action in the body:
Diuretics
Diuretics work by increasing urination to flush excess fluid and sodium from the body. This helps reduce blood volume and ease the workload on the heart and blood vessels.
Common diuretics include:
- Hydrochlorothiazide (HCTZ)
- Chlorthalidone
- Furosemide (Lasix)
- Metolazone
ACE inhibitors
ACE (angiotensin-converting enzyme) inhibitors block the formation of angiotensin II, a hormone that narrows blood vessels. This causes the vessels to relax and lower blood pressure.
Examples of ACE inhibitors:
- Captopril (Capoten)
- Enalapril (Vasotec)
- Lisinopril (Zestril, Prinivil)
- Ramipril (Altace)
Angiotensin II receptor blockers (ARBs)
ARBs work by blocking angiotensin II from binding to receptors on blood vessels, which also causes them to relax.
Some common ARBs:
- Losartan (Cozaar)
- Valsartan (Diovan)
- Irbesartan (Avapro)
- Candesartan (Atacand)
Calcium channel blockers
Calcium channel blockers prevent calcium from entering the heart and blood vessel cells, allowing the blood vessels to relax.
Examples of calcium channel blockers:
- Amlodipine (Norvasc)
- Diltiazem (Cardizem)
- Nifedipine (Adalat, Procardia)
- Verapamil (Calan, Isoptin)
Beta blockers
Beta blockers work by slowing the heart rate and reducing the force of the heart’s contractions. This lowers blood pressure.
Some beta blockers prescribed for high blood pressure:
- Atenolol (Tenormin)
- Bisoprolol (Zebeta)
- Metoprolol (Lopressor)
- Propranolol (Inderal)
Other drug classes
Less common medications used for hypertension include alpha blockers like doxazosin, direct vasodilators like hydralazine, and central agonists like clonidine.
In resistant cases, spironolactone or other potassium-sparing diuretics may be added. Amiloride and the alpha blocker doxazosin may also be used as fourth-line agents.
Most prescribed medications
Among the various drug classes, there are a handful of medications that stand out as the most commonly prescribed for high blood pressure in the United States:
| Medication | Drug class |
|---|---|
| Lisinopril | ACE inhibitor |
| Amlodipine | Calcium channel blocker |
| Hydrochlorothiazide (HCTZ) | Thiazide diuretic |
| Losartan | Angiotensin II receptor blocker (ARB) |
| Metoprolol | Beta blocker |
According to prescribing data, lisinopril is the most commonly prescribed medicine for hypertension. The ACE inhibitor lisinopril works to relax blood vessels and reduce blood volume. Amlodipine, HCTZ, losartan, and metoprolol are also top treatment choices used alone or in combination with other medications.
Recommended first-line treatments
The American College of Cardiology and American Heart Association guidelines provide evidenced-based recommendations for antihypertensive drug treatment.
For initial therapy, the guidelines suggest starting with one of these medication classes:
- Thiazide diuretic
- Calcium channel blocker
- ACE inhibitor
- Angiotensin II receptor blocker
Specific medication choices should be individualized based on effectiveness, safety, tolerability, and low cost. Fixed-dose combination therapy with two medications from different classes may also be considered for initial treatment.
Common medication combinations
Combination therapy using two or more medications at lower doses can enhance effectiveness and minimize side effects. It helps target multiple mechanisms for lowering blood pressure.
Some of the most common pairings include:
- ACE inhibitor + diuretic
- ARB + diuretic
- CCB + ACE inhibitor
- CCB + diuretic
- CCB + ARB
For example, the ACE inhibitor lisinopril is often prescribed with the diuretic HCTZ. This provides complementary effects by relaxing blood vessels (lisinopril) while also reducing fluid (HCTZ).
Changing medications if needed
If blood pressure is not adequately controlled on the initial medication or combination, the dose may be increased or additional drugs may be prescribed.
Some other options for modifying treatment include:
- Switching to a drug from another class
- Adding a drug from a different class
- Switching to a fixed-dose combination pill
For example, if an ACE inhibitor alone is not effective, the doctor may change to a diuretic or calcium channel blocker. Or they may add one of these other drugs and make it a combination therapy. The goal is to find the right medication regimen to successfully lower each patient’s blood pressure.
Lifestyle changes
While medication is often necessary to control high blood pressure, lifestyle changes remain critically important:
- Healthy diet: Focus on whole grains, fruits, veggies, lean protein, and low-fat dairy. Limit sodium, sugar, and refined carbs.
- Regular exercise: Aim for at least 30 minutes per day of moderate activity like brisk walking.
- Weight management: Reach and maintain a healthy body weight through diet and exercise.
- Reduce alcohol: Limit intake to no more than 1 drink per day for women or 2 for men.
- Don’t smoke: Quit smoking and avoid secondhand smoke.
- Manage stress: Try relaxation techniques, meditation, yoga, or counseling.
Adopting healthy lifestyle habits can help enhance blood pressure control when combined with medication. Work closely with your healthcare provider to create a comprehensive treatment plan.
Monitoring your blood pressure
With medication and lifestyle changes, regular follow-up is essential. Here are some tips for monitoring blood pressure:
- Check BP at home between doctor visits.
- Aim for readings consistently under 130/80 mmHg (or your goal set by your doctor).
- Keep a log of daily home BP readings to share with your physician.
- Don’t change or stop medication without consulting your healthcare provider.
- Schedule regular visits as recommended by your doctor.
- Report any side effects or issues with medications right away.
Ongoing monitoring and open communication with your medical team can help ensure your treatment plan successfully controls your blood pressure.
Conclusion
High blood pressure is a widespread issue that requires ongoing medical treatment. Lifestyle changes are also key. The most common and effective prescription medications for lowering blood pressure include diuretics, ACE inhibitors, ARBs, CCBs, and beta blockers.
Treatment plans are tailored to each patient’s specific health profile and needs. This may involve trying different drugs and combinations under medical supervision to determine the optimal regimen for keeping blood pressure controlled.
With proper adherence to medication, healthy habits, and regular monitoring, it’s possible to successfully manage high blood pressure and prevent the potentially serious complications.