If you’re trying to choose a blood pressure medication, it might feel like you’re wading through a sea of prescription drugs. The FDA lists approved blood pressure medications in 10 separate groups, with some groups containing over 20 drugs. With so many available medications for this common medical condition, it’s virtually impossible for patients to thoroughly educate themselves about every blood pressure drug on the market.
So, with such a steep number of hypertension drug options, what can patients do to find the best medication for their needs? In this article, we’ll explore the safest and most widely recommended blood pressure medications for patients to consider.
What Types of Blood Pressure Medications Are Available?
As we’ve already mentioned, the FDA breaks blood pressure medications into 10 separate categories, or “types”. The drugs in each category work differently to lower blood pressure. Here, we’ll dive into the details of the seven most common classifications on the FDA’s list: ACE inhibitors, beta-blockers, calcium channel blockers, alpha blockers, vasodilators, angiotensin II receptor blockers, diuretics, and combination medications.
ACE (angiotensin-converting enzyme) inhibitors are widely prescribed as a first-line treatment to lower blood pressure. So, if you’re going to start taking hypertension medication for the first time, there’s a strong chance that your physician will recommend an ACE inhibitor. Some of the most popular ACE inhibitors are lisinopril, benazepril, and enalapril.
This type of blood pressure medication works by blocking the production of angiotensin II, a hormone that constricts blood vessels. This action widens the blood vessels and lowers blood pressure.
Pros and Cons of ACE Inhibitors
Let’s cut to the chase: ACE inhibitors are a top choice for high blood pressure because they’re backed up by significant, longstanding clinical research. It goes without saying that if you’re taking a prescription medication, you want it to work, and ACE inhibitors have a demonstrated history of success for hypertension.
Another key benefit of ACE inhibitors for hypertensive patients is their preventative effects. In addition to reducing your blood pressure, this drug can help prevent future health problems, such as coronary artery disease, heart failure, and heart attacks.
Of course, as a prescription medication, ACE inhibitors can cause side effects. In most cases, these side effects are minor – severe complications from ACE inhibitors are rare. Nonetheless, you may experience dry cough, dizziness, headache, fatigue, and weakness while taking this type of medication.
Let’s move on to beta-blockers, a class of medication that blocks the effects of epinephrine, or adrenaline. In doing so, beta blockers reduce the speed and force of your heartbeat, leading to lower blood pressure.
Beta blockers are rarely used as the first-choice medication for high blood pressure. Instead, you may be prescribed this drug if other high blood pressure medications haven’t worked, or as one of multiple drugs to treat your hypertension.
Pros and Cons of Beta-Blockers
Beta-blockers are a great option to consider if your first-choice hypertension medication isn’t working for you. They can also work well in combination with other drugs, like ACE inhibitors and calcium channel blockers.
However, patients should be aware that beta-blockers can trigger a range of side effects, including fatigue, cold hands, digestive issues, and dizziness. Additionally, keep in mind that beta-blockers can interfere with the treatment of asthma and diabetes.
Calcium Channel Blockers
Calcium channel blockers keep calcium from reaching cells in the heart and arteries. Given that calcium leads to stronger contractions in the heart and arteries, calcium channel blockers relax the blood vessels and lower blood pressure.
Pros and Cons of Calcium Channel Blockers
Calcium channel blockers can be an excellent option for older adults and Black adults with hypertension. These demographics often respond well to this class of drugs, partially because they don’t cause adverse effects like sedation, depression, or salt and fluid retention. Additionally, calcium channel blockers can work well with other drugs, such as medication for high cholesterol, making it a safe choice for patients with certain underlying conditions.
On the other hand, patients with heart problems, liver problems, or irregular heart rhythms may not be able to take calcium channel blockers. This class of drug can also cause a variety of side effects, including dizziness, headaches, constipation, heartburn, and gingival hyperplasia (excessive gum growth around the teeth).
Peripherally Acting Alpha-Adrenergic Blockers
Commonly referred to as alpha blockers, this type of drug keeps norepinephrine from contracting the muscles in the walls of small veins and arteries. Usually, alpha blockers are used with other medications to treat high blood pressure, like diuretics, to manage difficult cases of hypertension.
Alpha blockers can cause side effects similar to those of other blood pressure drugs, including dizziness, weakness, headache, and pounding heartbeat. Additionally, this type of medication can alter the effects of other medications, making it crucial to talk to your doctor about all of the drugs you’re currently taking.
Vasodilators, as you may have guessed from the name, dilate the blood vessels. This is a broad drug classification that encompasses ACE inhibitors, angiotensin receptor blocks, nitrates, and calcium channel blockers. Examples include minoxidil and hydralazine, which are typically used to treat severe or chronic hypertension.
You may have heard diuretics called by their other name: water pills. This class of drug earned this name for its ability to flush salt and water from the body. Thiazide diuretics may be used to treat hypertension because they reduce the amount of fluid flowing through your circulatory system, leading to lower blood pressure.
Diuretics may be used to treat as the first-choice medication for hypertension in older adults and Black adults.
Angiotensin II Receptor Blockers
Angiotensin II receptor blockers, or ARBs, reduce the effects of angiotensin, a protein that narrows blood vessels. They’re used to treat both high blood pressure and heart failure.
You may be prescribed an ARB for hypertension if you were previously on an ACE inhibitor and experienced unwanted side effects. This is because in most cases, ARBs lead to fewer side effects than ACE inhibitors (though they can still cause dizziness).
Taking multiple medications can be very helpful for blood pressure management, especially in severe cases. So, your physician may recommend a combination pill. Oftentimes, combination blood pressure meds are available as a single pill, so you won’t have to take multiple pills throughout the day.
Most commonly, combination blood pressure drugs include an ARB and a thiazide diuretic, an ARB and a calcium channel blocker, or an ACE inhibitor and a calcium channel blocker.
How To Choose The Right Blood Pressure Medication For You
To hone in on the right blood pressure medication for you, let’s narrow down the options by demographic.
Patients With Severely High Blood Pressure
If you have a blood pressure reading of 140/90 or higher, you have what’s called stage 2 high blood pressure. To tackle it, your physician may recommend a combination blood pressure medication, right out of the gate.
Also known as combination therapy, combining multiple hypertension medications is often more effective for lowering high blood pressure. In fact, according to a study published in The Journal of Clinical Hypertension, combining drugs from complementary classes is around five times more effective in lowering blood pressure than upping the dose of a single drug.
Patients With Underlying Medical Conditions
If you have heart failure, kidney disease, diabetes, or a history of heart attack, you’ll need to consider blood pressure medications a little more carefully than the average adult. These underlying medical conditions rule out certain drugs that could put you at risk for serious complications.
- Patients with diabetes or kidney disease should consider blood pressure medications that prevent kidney damage, such as ACE inhibitors and ARBs.
- Physicians may recommend that patients with heart failure take a diuretic or beta blocker for high blood pressure.
Older Adults With High Blood Pressure
Older adults typically have more factors to consider when choosing a high blood pressure drug than their younger counterparts. Older patients are more likely to be taking prescription medications for other medical conditions, making drug interactions a major concern.
Nonetheless, if you’re over the age of 60, your physician can help you find a blood pressure medication that’s effective and doesn’t interact with your other medications. Typically, the first blood pressure medications to be recommended for older adults include ACE inhibitors, calcium channel blockers, and thiazide diuretics.
Take note that if you’re 60 or older, your physician probably won’t recommend beta blockers to manage your hypertension. This is because they can cause side effects that are particularly dangerous for older adults.
Younger Adults With High Blood Pressure
Unfortunately, young adults aren’t immune to the risk of developing high blood pressure. Around one in four adults between 20 and 44 have high blood pressure, making it a health risk worth paying attention to in early adulthood.
If you’ve been diagnosed with hypertension as a young adult, you’ll likely be prescribed an ACE inhibitor, beta blocker, or angiotensin-receptor blocker (ARB) to start.
- ACE inhibitors are generally recommended for younger adults with hypertension because they’re affordable and have a low risk of severe side effects.
- ARBs, like ACE inhibitors, reduce blood pressure while lowering the risk of stroke in some patients. This makes them a great option for managing high blood pressure in young adults.
- Beta blockers may be prescribed for young adults who aren’t good candidates for ARBs or ACE inhibitors.
Consulting Your Doctor About Blood Pressure Medications
Your physician’s advice is invaluable to choosing the best blood pressure medication for your needs. With the above information in mind, don’t hesitate to schedule an appointment with a doctor to complete your search for a suitable blood pressure drug.