DRUGS in BP Management

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Drug therapy for blood pressure includes various types of pills, and they all have some bothersome side-effect or the other. Doctors prescribe these drugs as for their perceived efficacy in managing our blood pressure to safer levels. This is invariably the sole concern of the prescribing physician. They hardly ever caution their patients about the possible side-effects of these drugs. And, they quite non-chalantly alter the dosage or the drug type if a particular patient does report back some side-effect, and if they do think of the alleged side-effect as potentially dangerous. To this extent, the patients seem to be nothing more than guinea pigs by the nexus of pharma companies and the physicians. For them, if patients do develop side-effects, it just goes into the profile database of that drug. That's about all.

Medicines used to treat high blood pressure include:

  • Water pills (diuretics). These drugs help remove sodium and water from the body. They are often the first medicines used to treat high blood pressure.

    There are different classes of diuretics, including thiazide, loop and potassium sparing. Which one your provider recommends depends on your blood pressure measurements and other health conditions, such as kidney disease or heart failure. Diuretics commonly used to treat blood pressure include chlorthalidone, hydrochlorothiazide (Microzide) and others.

    A common side effect of diuretics is increased urination. Urinating a lot can reduce potassium levels. A good balance of potassium is necessary to help the heart beat correctly. If you have low potassium (hypokalemia), your provider may recommend a potassium-sparing diuretic that contains triamterene.

  • Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels. They block the formation of a natural chemical that narrows blood vessels. Examples include lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others.
  • Angiotensin II receptor blockers (ARBs). These drugs also relax blood vessels. They block the action, not the formation, of a natural chemical that narrows blood vessels. angiotensin II receptor blockers (ARBs) include candesartan (Atacand), losartan (Cozaar) and others.

  • Calcium channel blockers. These drugs help relax the muscles of the blood vessels. Some slow your heart rate. They include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others. Calcium channel blockers may work better for older people and Black people than do angiotensin-converting enzyme (ACE) inhibitors alone.

    Don't eat or drink grapefruit products when taking calcium channel blockers. Grapefruit increases blood levels of certain calcium channel blockers, which can be dangerous. Talk to your provider or pharmacist if you're concerned about interactions.


Other medicines sometimes used to treat high blood pressure

If you're having trouble reaching your blood pressure goal with combinations of the above medicines, your provider may prescribe :


  • Alpha blockers. These medicines reduce nerve signals to blood vessels. They help lower the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.
  • Alpha-beta blockers. Alpha-beta blockers block nerve signals to blood vessels and slow the heartbeat. They reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).

  • Beta blockers. These medicines reduce the workload on the heart and widen the blood vessels. This helps the heart beat slower and with less force. Beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL, Kapspargo sprinkle) and others.

    Beta blockers aren't usually recommended as the only medicine prescribed. They may work best when combined with other blood pressure drugs.

  • Aldosterone antagonists. These drugs may be used to treat resistant hypertension. They block the effect of a natural chemical that can lead to salt and fluid buildup in the body. Examples are spironolactone (Aldactone) and eplerenone (Inspra).

  • Renin inhibitors. Aliskiren (Tekturna) slows the production of renin, an enzyme produced by the kidneys that starts a chain of chemical steps that increases blood pressure.

    Due to a risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs.

  • Vasodilators. These medicines stop the muscles in the artery walls from tightening. This prevents the arteries from narrowing. Examples include hydralazine and minoxidil.
  • Central-acting agents. These medicines prevent the brain from telling the nervous system to increase the heart rate and narrow the blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv) and methyldopa.

Always take blood pressure medicines as prescribed. Never skip a dose or abruptly stop taking blood pressure medicines. Suddenly stopping certain ones, such as beta blockers, can cause a sharp increase in blood pressure called rebound hypertension.


If you skip doses because of cost, side effects or forgetfulness, talk to your care provider about solutions. Don't change your treatment without your provider's guidance.


Treating resistant hypertension. You may have resistant hypertension if :


  • You take at least three different blood pressure drugs, including a diuretic. But your blood pressure remains stubbornly high.
  • You're taking four different medicines to control high blood pressure. Your care provider should check for a possible second cause of the high blood pressure.

Having resistant hypertension doesn't mean your blood pressure will never get lower. If you and your provider can determine the cause, a more effective treatment plan can be created.


Treating resistant hypertension may involve many steps, including :


  • Changing blood pressure medicines to find the best combination and dosage.
  • Reviewing all your medicines, including those bought without a prescription.
  • Checking blood pressure at home to see if medical appointments cause high blood pressure. This is called white coat hypertension.
  • Eating healthy, managing weight and making other recommended lifestyle changes.

High blood pressure during pregnancy. If you have high blood pressure and are pregnant, discuss with your care providers how to control blood pressure during your pregnancy.


Potential future treatments : Researchers have been studying the use of heat to destroy specific nerves in the kidney that may play a role in resistant hypertension. The method is called renal denervation. Early studies showed some benefit. But more-robust studies found that it doesn't significantly lower blood pressure in people with resistant hypertension. More research is underway to determine what role, if any, this therapy may have in treating hypertension.


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