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Choosing blood pressure medications
Choosing the right high blood pressure medication can be tricky. Find out which of the various drug options is appropriate for you.
By Mayo Clinic staffDozens of high blood pressure medications (antihypertensives) are available, each with pros and cons. Depending on how high your blood pressure is, your doctor may prescribe one or more high blood pressure medications to treat your condition. For everyone who has high blood pressure or is at risk of developing high blood pressure, lifestyle changes can help keep your numbers under control. Before beginning blood pressure treatment, it's a good idea to understand the options available to you.
For everyone with high blood pressure and people with prehypertension (120/80 to 139/89)
Whether you're on the road to developing high blood pressure (prehypertension) or you already have high blood pressure (hypertension), you can benefit from lifestyle changes that can lower your blood pressure. People who have prehypertension have a systolic pressure (top number) ranging from 120 to 139 millimeters of mercury (mm Hg) or a diastolic pressure (bottom number) ranging from 80 to 89 mm Hg.
Even if your doctor prescribes medications to control your blood pressure, he or she will likely recommend you make lifestyle changes, as well. Lifestyle changes can reduce or eliminate your need for medications to control your blood pressure. These changes include:
- Don't smoke.
- Eat a healthy diet, focusing on fruits, vegetables and low-fat dairy products, and especially, control your salt (sodium) intake.
- Maintain a healthy weight.
- Exercise by getting 30 minutes of moderate activity — even if you need to break up your activity into three 10-minute sessions — on most days of the week.
- Limit the amount of alcohol you drink — one drink a day for women and two a day for men.
You probably won't need to take high blood pressure medications if you have prehypertension but are otherwise healthy. However, if you have prehypertension and diabetes, kidney disease or heart disease, your doctor might prescribe medications to lower your blood pressure to a more desirable level.
For people who have stage 1 high blood pressure (140/90 to 159/99)
If you have stage 1 high blood pressure, you have a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg. If both numbers are in this range, you also have stage 1 high blood pressure.
The first medication your doctor may suggest is a diuretic - also called water pills. Diuretics work by flushing excess water and sodium from the body, thus lowering blood pressure, which may be enough along with lifestyle changes to control your blood pressure.
Follow healthy lifestyle habits along with medications to treat high blood pressure.
Although three types of diuretics are available, the first choice is usually a thiazide diuretic. Thiazide diuretics typically have fewer side effects than do other types of diuretics. They also offer strong protection against conditions that high blood pressure can cause, such as stroke and heart failure.
A diuretic may be the only high blood pressure medication you need. But under some circumstances, your doctor may also recommend adding another medication. Those choices include:
- Angiotensin-converting enzyme (ACE) inhibitors. These help blood vessels relax by blocking the production of a hormone that causes blood vessels to narrow. Frequently prescribed ACE inhibitors include captopril (Capoten), lisinopril (Prinivil, Zestril) and ramipril (Altace).
- Angiotensin II receptor blockers. These allow blood vessels to widen by preventing a hormone called angiotensin from affecting vessels. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), olmesartan (Benicar) and valsartan (Diovan).
- Beta blockers. These work by reducing nerve signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and penbutolol (Levatol).
- Calcium channel blockers. These prevent calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat, Procardia).
Adding one of these medications can lower your blood pressure more quickly than can taking only a diuretic. This may reduce the risk of developing complications from high blood pressure. Combining two medications may also allow you to take a smaller dose of each, which can reduce side effects and perhaps be less expensive. The choice of medications in combination depends on your individual circumstances.
Next page(1 of 2)
- Chobanian AV, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. New England Journal of Medicine. 2003;289:2560.
- Sheps SG, ed. Mayo Clinic 5 Steps to Controlling High Blood Pressure. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2008.
- Initial antihypertensive therapy: Drugdex Consults. Micromedex Healthcare Series. http://www.micromedex.com/. Accessed Nov. 12, 2008.
- Control your risk factors for high blood pressure. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=581. Accessed Nov. 21, 2008.
- Taking medication for high blood pressure. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=2141. Accessed Nov. 21, 2008.
