- What Is HBP?
- Most Common Medications
- The Best HBP Medication
- 10 HBP Drug Classes
- HBP Medication List
- HBP Drug Side Effects
- Safe to Take During Pregnancy
- Safe to Take With Alcohol
- Weight Gain
What is high blood pressure (HBP, hypertension)?
High blood pressure, also known as hypertension, affects nearly a third of all Americans. With hypertension, too much force is exerted on the arteries as blood is pumped through. This results not only in damage to the blood vessels themselves but to other organs forced to bear the stress.
Blood pressure is assessed using two parameters -- the systolic and diastolic pressures -- which measure, respectively, the maximum pressure exerted in the arteries as the heart contracts and the minimum pressure in those vessels between cardiac contractions. In adults, blood pressure is considered normal if the top number (systolic pressure) is between 90 and 120 and the bottom number (diastolic) is between 60 and 80.
What are the most common blood pressure medications?
In terms of dollar sales, there are 5 top high blood pressure medications.
- the angiotensin II receptor blocker valsartan (Diovan) in the lead for high blood pressure medications,
- the beta-blocker metoprolol,
- the generic combination of valsartan and HCTZ,
- olmesartan (Benicar), and
- olmesartan and HCTZ (Benicar HCT).
In terms of prescriptions written, here are the top 4 high blood pressure medications,
What is the best high blood pressure medication?
Selecting the "best" high blood pressure medication depends on several things, including the general health of the patient, his or her age, ethnicity, and whether or not they have any co-existing medical issues or drug sensitivities.
For example, in a hypertensive patient with asthma, it may be inadvisable to prescribe a beta-blocker, as these drugs can aggravate that respiratory condition. Similarly, in patients prone to constipation (the elderly, for example) use of certain calcium channel blockers might best be avoided -- along with diuretics -- as both these classes of drugs can inhibit proper bowel function.
African-American patients respond to some antihypertensive medications better than others.
Certain groups of patients require the use of a specific class of high blood pressure medication. These include:
- The drug of choice for hypertensive, pregnant women is one of the oldest high blood pressure medications on the market. Methyldopa, which works to lower blood pressure through the central nervous system, has the lowest risk of harming the mother and developing the fetus.
- Other possible safe options include labetalol, beta-blockers, and diuretics.
- Two classes of drugs that should never be used during pregnancy include ACE inhibitors and angiotensin II receptor blockers.
Hypertension in African-Americans tends to occur earlier in life and tends to be more severe. Plus, some medications that work to lower blood pressure in other ethnicities may have limited effect on African-Americans. Thiazide diuretics (such as HCTZ) or a calcium channel blocker are recommended first choices along with the possible add-on of a second drug from either the ACE inhibitor class or the angiotensin II receptor blocker group.
With age, comes an increased risk for systolic hypertension which can be aggravated by severe atherosclerosis.
- According to one study, the diuretic chlorthalidone (Hygroton) had significant benefits in elderly patients with systolic hypertension.
- Along with a diuretic, some calcium channel blockers, ACE inhibitors, and angiotensin II receptor blockers may also be good choices.
- However, beta-blockers may not be as effective for hypertension in those over 60; though they may be good choices if co-existing heart disease is present.
- It also may be preferable in elderly patients to give two high blood pressure medications at a low dose versus one at a higher dose.
High blood pressure medication list
There are several classes of blood pressure medications. Each class lowers blood pressure in a different way. Here are 10 different classes of blood pressure medications.
- ACE inhibitors
- Angiotensin II receptor blockers
- Calcium channel blockers
- Alpha-2 receptor agonist
- Central agonists
- Peripheral adrenergic inhibitors
Diuretics increase urination which reduces sodium and fluid in the body. That can help lower blood pressure because it lowers blood volume. Mild hypertension can sometimes be treated using diuretics alone, although they are more commonly used in combination with other high blood pressure medications. Examples of diuretics include:
- Bumetanide (Bumex)
- Chlorthalidone (Hygroton)
- Chlorothiazide (Diuril)
- Ethacrynate (Edecrin)
- Furosemide (Lasix)
- Hydrochlorothiazide HCTZ (Esidrix, Hydrodiuril, Microzide)
- Indapamide (Lozol)
- Methyclothiazide (Enduron)
- Metolazone (Mykroz, Zaroxolyn)
- Torsemide (Demadex)
One side effect of diuretics is a loss of potassium, which is carried out of the body in urine along with sodium. Potassium is needed for proper muscular movement and a deficiency of this mineral can result in fatigue, weakness, leg cramps, and even problems with the heart. So often, patients on traditional diuretics will be advised to take their medication with a potassium-rich food, such as orange juice or a banana, or they'll be prescribed a potassium supplement.
Some diuretics were subsequently developed to address the issue of potassium loss. These blood pressure medications are known as "potassium-sparing" diuretics. They include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium).
Finally, there are combination diuretics, which include a potassium-sparing agent and a traditional diuretic. These include amiloride hydrochloride and hydrochlorothiazide HCTZ (Moduretic), spironolactone and HCTZ (Aldactazide), and triamterene and HCTZ (Dyazide, Maxzide).
Beta-blockers lower blood pressure by acting directly on the heart. These high blood pressure medications reduce heart rate and force of pumping, as well as reduce blood volume. Beta-blockers include:
- Acebutolol (Sectral)
- Atenolol (Tenormin)
- Bisoprolol fumarate (Zebeta)
- Carvedilol (Coreg) -- Combined alpha/beta-blocker
- Esmolol (Brevibloc)
- Labetalol (Trandate, Normodyne) -- Combined alpha/beta-blocker
- Metoprolol tartrate (Lopressor) and metoprolol succinate (Toprol-XL)
- Nadolol (Corgard)
- Nebivolol (Bystolic)
- Penbutolol sulfate (Levatol)
- Propranolol (Inderal)
- Sotalol (Betapace)
- HCTZ and bisoprolol (Ziac) is a beta blocker plus diuretic
Angiotensin is a hormone in the body that causes blood vessels to narrow. The angiotensin-converting enzyme (ACE) inhibitors decrease the production of angiotensin and, in turn, help lower blood pressure. Examples of ACE inhibitors include:
Angiotensin II receptor blockers
The hormone angiotensin narrows blood vessels, but to do its job it needs a place to bind. That's where angiotensin II receptor blockers come in. They prevent angiotensin from binding to receptors on the blood vessels and that helps lower blood pressure. Angiotensin II receptor blockers include:
Calcium channel blockers
Calcium increases the strength and force of contractions in the heart and blood vessels. Blocking its entry into smooth muscle tissue reduces this effect. Calcium channel blockers lower blood pressure by relaxing blood vessels and reducing heart rate. Examples of calcium channel blockers include:
- Amlodipine besylate (Norvasc, Lotrel)
- Clevidipine (Cleviprex)
- Diltiazem hydrochloride (Cardizem CD, Cardizem SR, Dilacor XR, Tiazac)
- Felodipine (Plendil)
- Isradipine (DynaCirc, DynaCirc CR)
- Nicardipine (Cardene SR)
- Nifedipine (Adalat CC, Procardia XL)
- Nimodipine (Nimotop, Nymalize)
- Nisoldipine (Sular)
- Verapamil hydrochloride (Calan SR, Isoptin SR, Verelan, Covera HS)
Alpha-2 receptor agonist
Methyldopa, formerly known under the brand name Aldomet, is one of the oldest blood pressure medications still in use.
- It was first introduced more than 50 years ago.
- Methyldopa works in the central nervous system to lower blood pressure.
- While its general use has declined over the years, methyldopa is considered the first line of treatment for high blood pressure that develops during pregnancy.
Some hypertension medications work in the central nervous system rather than directly on the cardiovascular system. Central agonists thus have a tendency to cause drowsiness. Drugs in this class include
Peripheral adrenergic inhibitors
There was a time when the high blood pressure medication list was very short indeed. In the 1950s, reserpine was one of the few products on the market to treat hypertension. It is rarely used due to its numerous side effects and drug interactions. The peripheral adrenergic inhibitors work in the brain to block signals that tell blood vessels to constrict. They are mostly used when other high blood pressure medications fail to solve the problem. The peripheral adrenergic inhibitors include
- Guanadrel (Hylorel),
- guanethidine monosulfate (Ismelin), and
- reserpine (Serpasil).
What are common high blood pressure side effects?
Different classes of blood pressure medications have different side effects.
- Diuretics can lead to an increase in potassium loss, known as hypokalemia, which, in turn, can affect muscular function -- including the muscles of the heart.
- There is also an increased risk for gout with diuretics -- as well as the possibility of weakness, thirst, dehydration, and increased urination.
- Changes in blood sugar levels are also possible.
- Skin reactions, some severe, are possible with thiazide diuretics (such as hydrochlorothiazide).
- Potassium-sparing diuretics, such as spironolactone (Aldactone) may cause breast enlargement in males.
Beta-blockers cause the heart to slow down and so some of their side effects can be traced to that mechanism of action.
- Dizziness, weakness, fatigue, and fainting are possible.
- Beta-blockers also affect the respiratory system, so other side effects include shortness of breath, difficulty breathing, and chest pain.
- Beta-blockers should not be withdrawn suddenly, as that could result in a heart attack or sudden death.
- The most common side effect of ACE Inhibitors is also an unusual one -- a dry cough. Usually, it goes away with continued use of the drug, but that could take weeks.
- ACE Inhibitors could reduce blood pressure too much, resulting in hypotension which could, in turn, lead to headache, dizziness, fainting, and reduced kidney function.
Angiotensin II receptor blockers
- The most common side effect of angiotensin receptor blockers (ARBs) is an increased potassium level in the blood, known as hyperkalemia.
- Dizziness is also common, along with fatigue.
- Upper respiratory tract infections have also been reported -- along with gastrointestinal issues such as upset stomach and diarrhea.
Calcium channel blockers
Up to a third of patients may experience the following side effects with calcium channel blockers:
- Swelling of the ankles and other extremities,
- flushing, and
- Other common side effects include heartburn and nausea.
A common, transient, but distressing initial side effect of the alpha-blockers is
- postural hypotension.
- This is a sudden drop in blood pressure when standing up.
- It can be severe enough to cause dizziness or even fainting.
- Also, alpha-blockers can result in increased heart rate, headache, nausea, and weakness.
Methyldopa is mostly well-tolerated, but some patients may experience
- headache, and
- dry mouth.
- Up to 40% of patients taking clonidine (Catapres) will experience dry mouth and about a third will have drowsiness, headache, and sleepiness.
- Other common side effects include constipation, dizziness, and local skin reactions with the use of the Catapres-TTS skin patch.
- Reserpine use is linked with possible side effects including nightmares, stuffy nose, depression, and an inability to fall asleep. Diarrhea and heartburn are also possible.
- Guanadrel and guanethidine can cause diarrhea and other gastrointestinal issues – as well as dizziness and drowsiness.
- Taking minoxidil might result in excessive body hair growth, as well as weight gain and dizziness.
- Hydralazine is linked to headaches, heart palpitations, swelling around the eyes, and aches and pains in the joints.
Is it safe to take high blood pressure medication during pregnancy?
Some high blood pressure medications should absolutely NOT be used during pregnancy as they may harm the mother and developing fetus. These medications include
- ACE inhibitors and
- angiotensin II receptor blockers.
- Reserpine may also be harmful during pregnancy and should only be used when no other alternatives exist.
Safe medications to use include methyldopa and potentially some diuretics and beta-blockers, including labetalol.
Is it safe to drink alcohol while taking high blood pressure medications?
Some high blood pressure medications initially cause drowsiness, dizziness, and lightheadedness. Some even cause fainting on the first dose. The body usually adjusts to the effects of these medications and the side effects disappear. Consuming alcohol during the early phase of antihypertensive treatment could be risky because alcohol can also cause
- drowsiness, and
Also, alcohol consumption causes a transient rise in blood pressure that could persist if the drinking is beyond the level of "moderation."
Does high blood pressure lead to weight gain?
Some high blood pressure medications can, in fact, lead to weight gain. Common offenders include older beta-blockers such as propranolol (Inderal) and atenolol (Tenormin). There could be several reasons for this -- including the fact that the medications can make patients feel tired and thus less likely to exercise.
- Minoxidil tablets (Loniten) -- used only when other antihypertensive medications have failed -- can also cause weight gain.
- Weight gain is also listed as a common side effect of doxazosin (Cardura). Diuretics are more likely to cause weight loss.
Robert J. Bryg, MD
Board Certified Internal Medicine with subspecialty in Cardiovascular Disease