High blood pressure medications do not all work the same way. Some relax blood vessels. Others remove excess sodium and fluid, slow the heart rate, or block hormones that raise blood pressure. The right medication depends on factors such as a person's blood pressure readings, age, kidney function, heart conditions, other medications, pregnancy status, and previous side effects.
The American Heart Association identifies several major classes of blood pressure medications, including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-blockers, alpha-blockers, central agents, and vasodilators.1
ACE Inhibitors
Common examples include:
- Lisinopril
- Enalapril
- Benazepril
- Ramipril
ACE inhibitors reduce the production of a hormone that can narrow blood vessels. This allows blood vessels to relax and can lower blood pressure.
They may also be prescribed for certain patients with heart failure, kidney disease, diabetes, or a history of heart attack.
Possible side effects include:
- Dry cough
- Dizziness
- Increased potassium
- Changes in kidney function
- Rare but serious swelling of the face, lips, tongue, or throat
Swelling of the face or throat requires urgent medical attention.
ACE inhibitors are generally avoided during pregnancy.1
Angiotensin Receptor Blockers
Common examples include:
- Losartan
- Valsartan
- Irbesartan
- Olmesartan
Angiotensin receptor blockers, commonly called ARBs, affect the same hormone system as ACE inhibitors but work at a different point in the pathway.
ARBs are sometimes used when an ACE inhibitor causes a persistent cough.
Potential concerns include dizziness, elevated potassium, and changes in kidney function. They are also generally avoided during pregnancy.
Calcium Channel Blockers
Common examples include:
- Amlodipine
- Nifedipine
- Diltiazem
- Verapamil
Calcium channel blockers reduce the movement of calcium into certain heart and blood-vessel cells.
Some primarily relax blood vessels. Others can also slow the heart rate.
Possible side effects include:
- Swelling of the ankles or feet
- Flushing
- Headache
- Dizziness
- Constipation
- Slow heart rate with certain products
Do not assume every calcium channel blocker can be substituted for another. Their effects and uses differ.
Diuretics
Common examples include:
- Hydrochlorothiazide
- Chlorthalidone
- Furosemide
- Spironolactone
Diuretics help the body remove sodium and water. This can reduce fluid volume and lower blood pressure.
Different types of diuretics affect the kidneys and electrolytes differently.
Monitoring may include:
- Potassium
- Sodium
- Kidney function
- Blood pressure
- Fluid status
Some diuretics can lower potassium, while others may raise it.
Beta-Blockers
Common examples include:
- Metoprolol
- Carvedilol
- Atenolol
- Propranolol
Beta-blockers slow the heart rate and reduce the effects of certain stress hormones.
They may be used for conditions such as:
- Heart failure
- Previous heart attack
- Abnormal heart rhythms
- Angina
- Migraine prevention
- Tremor
Possible side effects include fatigue, dizziness, slower heart rate, and reduced exercise tolerance.
Some beta-blockers can affect breathing and blood-sugar awareness. Do not stop one suddenly without instructions from a healthcare professional.
Why Are Two or More Medications Sometimes Needed?
Blood pressure is controlled by several systems in the body. One medication may not be enough to reach an individual treatment goal.
Using lower doses of two complementary medications may sometimes control blood pressure more effectively than continually increasing one medication.
Combination tablets can also reduce the number of pills a patient takes.
Can OTC Medications Raise Blood Pressure?
Yes. Some nonprescription products and supplements can interfere with blood pressure control.
Examples may include:
- Decongestants
- NSAID pain relievers
- Stimulants
- Certain weight-loss products
- High-sodium remedies
- Some herbal supplements
The American Heart Association recommends checking with a healthcare professional before taking OTC medicines or supplements when you have high blood pressure.2
Questions to Ask Your Pharmacist
- What class of medication is this?
- When should I take it?
- Should I monitor my blood pressure at home?
- Can it affect potassium or kidney function?
- Does it interact with OTC medicines?
- What should I do if I feel dizzy?
- Should I avoid grapefruit, salt substitutes, or alcohol?
- Can this medication be stopped suddenly?
The Bottom Line
Blood pressure medications are not interchangeable tools from the same toolbox. Each class works differently and carries different monitoring needs. Know the medication name, why you take it, and which side effects require attention.
Frequently Asked Questions
Why would I need two blood pressure medications instead of one?
Blood pressure is controlled by several body systems, so one medication may not be enough. Lower doses of two complementary medications can sometimes control blood pressure more effectively, with fewer side effects, than continually increasing a single drug.
Why do ACE inhibitors cause a cough?
ACE inhibitors can cause a dry cough in some patients. If this happens, a prescriber may switch to an ARB, which works on the same hormone system at a different point in the pathway and typically doesn't cause the same cough.
Can I take ibuprofen if I have high blood pressure?
NSAIDs like ibuprofen can raise blood pressure and interfere with blood pressure medications. Check with a healthcare professional before regular use if you have hypertension.
Are ACE inhibitors and ARBs safe during pregnancy?
No, these classes are generally avoided during pregnancy. Anyone taking an ACE inhibitor or ARB who is pregnant or planning pregnancy should talk with their healthcare team promptly.
Know the medication name, why you take it, and which side effects require attention. Blood pressure medications are not interchangeable tools from the same toolbox.
References
- American Heart Association. Types of Blood Pressure Medications. heart.org/en/health-topics/high-blood-pressure
- American Heart Association. Understanding Over-the-Counter (OTC) Medications and High Blood Pressure. heart.org/en/health-topics/high-blood-pressure