A Guide to Blood Pressure Medications
Hypertension (high blood pressure) affects about half of the U.S. adult population. In 2020, about 120,000 U.S. deaths were attributed to high blood pressure. Only cigarette smoking is a higher preventable risk factor for cardiovascular deaths in the U.S.
For most people, the first step in managing high blood pressure is to make diet and lifestyle changes. If this does not work or your blood pressure is very high, your doctor may suggest prescription medications. These medications lower blood pressure and reduce the strain on your heart and blood vessels through various mechanisms.
Table of Contents
Diagnosing High Blood Pressure
Blood pressure is a measurement of the pressure exerted by circulating blood on the walls of arteries, similar to the pressure exerted by water on the walls of a hose. Systolic pressure is measured when the lower chambers of the heart contract and push blood into the circulation. Diastolic pressure is the number recorded when the heart relaxes.
Blood pressure is measured in millimeters of mercury (mm Hg) and recorded as a ratio, with the top number being the systolic pressure and the bottom number being the diastolic pressure.
A normal systolic blood pressure should be less than 120 mm Hg, and a normal diastolic blood pressure should be less than 80 mm Hg.
| Systolic | Diastolic | |
| Normal | Less than 120 | Less than 80 |
| Elevated | 120-129 and | Less than 80 |
| Stage 1 hypertension | 130-139 or | 80-89 |
| Stage 2 hypertension | 140 or higher or | 90 or higher |
| Hypertension Crisis | 180 or higher and/or | Higher than 120 |
A blood pressure cuff is used to measure blood pressure by slowly inflating and deflating the cuff, which causes turbulence in the blood flow.
Since blood pressure can fluctuate from minute to minute, it is important to take multiple measurements at different times of the day and over an extended period. Blood pressure is affected by stress, body position, hydration, cuff size, hormone levels, salt in the diet, medications, and other variables.
To determine the correct blood pressure cuff size, measure the circumference of your upper arm using a tape measure. A standard adult cuff should work if your arm circumference is between 10 inches (27 cm) and 13 inches (34 cm). A large adult cuff should be used if your arm circumference is between 13 inches (35 cm) and 17 inches (44 cm). Using a cuff that is too small will falsely elevate your blood pressure. Small adult (22-26 cm) and extra-large (45-52 cm) cuffs are also available.
When taking your blood pressure:1
- Avoid caffeine, alcohol, tobacco use, or exercise within 30 minutes of taking your blood pressure.
- Sit upright with your back against the back of the chair and your feet flat on the floor.
- Avoid tight-fitting clothing.
- Wrap the blood pressure cuff around your upper arm, not over clothing.
- Place your arm on the table with your palm up so the cuff is even with your heart.
- Push start on the machine and sit quietly until your blood pressure is measured.
- Recheck your blood pressure on the other arm.
When your blood pressure is too high, it puts added stress on your blood vessels, increasing your risk for a heart attack, stroke, or kidney disease. Unfortunately, high blood pressure rarely causes symptoms, so you must be proactive about measuring your blood pressure regularly. Contact a doctor on call on the Telegra MD platform to discuss your blood pressure readings and receive a proper diagnosis.
Types of Blood Pressure Medications2,3
To reduce blood pressure, medications either reduce blood volume (diuretics), decrease the force with which the heart is contracting, or decrease blood vessel tone.
Diuretics
Diuretics (water pills) increase urination and help your body eliminate excess sodium and water. By doing so, your blood volume decreases, which decreases your blood pressure. Common types of diuretics include thiazide diuretics, loop diuretics, and potassium-sparing diuretics. These medications act in various regions of the tiny filtration units in the kidneys called nephrons.
When taking diuretics, your doctor may monitor for low sodium, low potassium, increased uric acid, and increased calcium levels. Diuretics may worsen gout symptoms.
Beta-blockers
Beta-blockers decrease how fast and strongly your heart contracts. If the heart generates less force, less will be transmitted to the large arteries, decreasing blood pressure. Beta-blockers also relax the muscles lining blood vessels. Beta-blockers are frequently chosen for people with a history of irregular heart rhythms or a history of a heart attack.
Beta-blockers may worsen shortness of breath if you have asthma or chronic obstructive pulmonary disease, increase the risk of sexual dysfunction and peripheral artery disease symptoms, and cause fatigue and depression.
ACE inhibitors
Angiotensin-Converting Enzyme (ACE) Inhibitors block the production of angiotensin II, a hormone that narrows the lumen of blood vessels, which increases resistance and blood pressure. ACE inhibitors block the action of angiotensin II by dilating blood vessels and reducing the strain on the heart.
ACE inhibitors should not be used with ARBs. Avoid ACE inhibitor use during pregnancy. They may cause coughing, a decreased sense of taste, and increased potassium levels.
Angiotensin II receptor blockers
Angiotensin II Receptor Blockers (ARBs) block the effects of angiotensin II by blocking its ability to bind to its receptor. As with ACE inhibitors, ARBs cause the muscles lining blood vessels to relax and decrease blood pressure.
ARBs should not be used with ACE inhibitors. Avoid ARB use during pregnancy. They can cause allergic reactions, dizziness, and high potassium levels.
Calcium channel blockers
Calcium is essential for muscle cells to contract. Calcium channel blockers reduce calcium from entering the heart and blood vessel muscle cells, causing them to relax. Decreasing the strength of heart muscle contraction and dilating blood vessels decreases blood pressure.
Calcium-channel blockers may cause leg swelling, headaches, and constipation.
Alpha-blockers
Alpha-blockers block nerve action at adrenergic receptors. Blocking these receptors relaxes the smooth muscle lining blood vessels and lowers blood pressure. Alpha-blockers are also used to treat benign prostatic hypertrophy (BPH).
Alpha-blockers are not usually chosen as a first-line treatment option for high blood pressure. They are often used in combination with other medications.
Centrally acting agents
These medications reduce sympathetic nerve impulses from the brain and spinal cord. They slow heart rate and contractility and dilate blood vessels. They are not used as much because they cause dry mouth and drowsiness.
Vasodilators
Vasodilators are medications that relax muscles lining blood vessels, causing the blood vessels to widen. This causes a decrease in blood pressure.
These medications are commonly combined with others, such as diuretics, because they cause a fast heart rate and fluid retention.
Combinations
Some medications that lower blood pressure by different mechanisms can be combined to be more effective.
Choosing the Right Blood Pressure Medication
Your doctor will select medications from these classes based on any other medical issues you may have, contraindications to using certain classes of medications, medication allergies, stroke, and heart disease risk factors, and your expected response to medications in a medication class. Finding the best medication class and dosage to control your symptoms with the fewest side effects may take some trial and error.
When talking to your doctor about your blood pressure, it is important to disclose all medical conditions you have been diagnosed with as well as all medications and supplements, both prescription and over the counter, you are taking. This will reduce your risk of side effects.
Some blood pressure medications work better in some ethnic and racial groups. For example, beta-blockers are less effective in reducing blood pressure in Black people. They are also not recommended for people with or at increased risk of diabetes.3
ARBs and ACE inhibitors are not used during pregnancy.
Because there are many classes of blood pressure medications, it may take some trial and error to determine the best medication option for you. Many people find that finding reputable, licensed, and board-certified doctors through telehealth can be a convenient solution for monitoring and treating their blood pressure and receiving an online prescription.
Telehealth is typically more cost-effective than in-person appointments, which is especially valuable when managing a health concern such as high blood pressure that may require several doctor visits to optimize your treatment.
Lifestyle Modifications and Medication
There are no over-the-counter blood pressure medications available in the United States. However, lifestyle modifications are an important part of your treatment plan for managing high blood pressure.
Lifestyle medications that can reduce blood pressure include:
- Consuming a heart-healthy diet: The DASH diet is highly recommended to reduce blood pressure. This diet primarily comprises fruits, vegetables, nuts, and low-fat dairy products.4,5
- Taking heart-healthy supplements: Supplements such as omega-3 fatty acids, magnesium, and fiber have scientific support for their heart-healthy benefits.
- Engaging in regular physical activity: Movement throughout the day and formal exercise decrease blood pressure in three-quarters of people with high blood pressure. The expected decreases are 11 mm Hg systolic and 8 mm Hg diastolic.6
- Managing your weight and body composition: The Framingham Heart Study and others have demonstrated a direct relationship between weight gain and blood pressure. Obesity may contribute to 40% of high blood pressure and even as much as 78% of high blood pressure risk in men and 65% in women.7,8
- Learning stress reduction techniques: Stress increases sympathetic nervous system activity. The sympathetic nervous system (fight-or-flight) increases heart rate, heart contractility, and blood pressure and constricts blood vessels. 9
- Limiting alcohol consumption: Excessive alcohol consumption affects the release of hormones that regulate blood vessel constriction and dilation.
- Quitting smoking: Smoking narrows blood vessels, increasing blood vessel resistance and blood pressure. It also damages the lining of blood vessel walls and causes them to become less flexible.10
- Decrease sodium intake: Water follows sodium into the bloodstream. A diet high in sodium pulls water into blood vessels, increasing blood pressure.11
Adherence and Monitoring
Most people expect to see an obvious result when they take medications, such as a reduction in fever or pain or a decrease in bothersome symptoms. High blood pressure does not cause symptoms. You are taking medication to lower your blood pressure and reduce your risk of cardiovascular disease.
Medication adherence and taking medications as prescribed are essential to protect your heart, brain, blood vessels, and kidneys from high blood pressure. Some people find setting reminders and organizing pillboxes can make it easy to remember to take medication on time.
Your blood pressure changes throughout the day and in response to various stresses. Monitor your blood pressure regularly, even if you do not have high blood pressure. If you are taking medications to reduce your blood pressure, it is important to monitor your blood pressure to assess medication effectiveness and make any necessary adjustments.
Disclaimer
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
References:
1. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018 Jun;71(6):1269-1324. doi: 10.1161/HYP.0000000000000066. Epub 2017 Nov 13. Erratum in: Hypertension. 2018 Jun;71(6):e136-e139. Erratum in: Hypertension. 2018 Sep;72(3):e33. PMID: 29133354.
2. American Heart Association. Types of Blood Pressure Medications
3. Weber, M.A., Schiffrin, E.L., White, W.B., Mann, S., Lindholm, L.H., Kenerson, J.G., Flack, J.M., Carter, B.L., Materson, B.J., Ram, C.V.S., Cohen, D.L., Cadet, J.-C., Jean-Charles, R.R., Taler, S., Kountz, D., Townsend, R.R., Chalmers, J., Ramirez, A.J., Bakris, G.L., Wang, J., Schutte, A.E., Bisognano, J.D., Touyz, R.M., Sica, D. and Harrap, S.B. (2014), Clinical Practice Guidelines for the Management of Hypertension in the Community. J Clin Hypertens, 16: 14-26. https://doi.org/10.1111/jch.12237
4. Appel, L.J., Moore, T.J., Obarzanek, E., et al. (1997). A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med; 336: 1117–24.
5. Bazzano, L. A., Green, T., Harrison, T. N., & Reynolds, K. (2013). Dietary approaches to prevent hypertension. Current Hypertension Reports, 15 (6), 694–702. https://doi.org/10.1007/s11906-013-0390-z
6. Hagberg, J.M., Park, J.J., & Brown, M.D. (2000). The role of exercise training in the treatment of hypertension: an update. Sports Med. (3):193-206. DOI: 10.2165/00007256-200030030-00004. PMID: 10999423.
7. Willett, W. C., Manson, J. E., Rosner, B., & et al. (1998). Body Weight, Weight Change, and Risk for Hypertension in Women. Annals of Internal Medicine 128:81-88. DOI: https://doi.org/10.7326/0003-4819-128-2-199801150-00001
8. Garrison, R., Kannel, W., Stockes, J., & Castelli, W. (1987). Incidence and precursors of hypertension in young adults: The Framingham offspring study. Preventive Medicine. 16 (2), 235-251 https://doi.org/10.1016/0091-7435(87)90087-9
9. Kulkarni, S., O’Farrell, I., Erasi, M., & Kochar, M.S. (1998). Stress and hypertension. WMJ.; 97 (11):34-8. PMID: 9894438.
10. Rehill, N., Beck, C. R., Yeo, K. R., & Yeo, W. W. (2006). The effect of chronic tobacco smoking on arterial stiffness. British journal of clinical pharmacology, 61(6), 767–773. https://doi.org/10.1111/j.1365-2125.2006.02630.x
11. Bray, G.A., Vollmer, W.M., Sacks, F.M., Obarzanek, E., Svetkey, L.P., & Appel, L.J.; DASH Collaborative Research Group. (2004). A further subgroup analysis of the effects of the DASH diet and three dietary sodium levels on blood pressure: results of the DASH-Sodium Trial. Am J Cardiol.: 94 (2):222-7. DOI: 10.1016/j. amjcard.2004.03.070. Erratum in: Am J Cardiol. 2010 Feb 15; 105 (4):579. PMID: 15246908.
