What medications are used to treat high blood pressure?

There are various kinds of antihypertensives. The following are the most commonly used:

• ACE inhibitors
• Sartans (angiotensin receptor blockers, or ARBs)
• Diuretics
• Calcium channel blockers (CCBs)

Beta blockers also used to be used to lower blood pressure. But they are no longer used as the first line of treatment because they have a weak effect – unless you happen to have other health problems, like heart failure.

All of these medications can prevent long-term effects of high blood pressure. the one that is most suitable for your individual situation depends on various factors – most of all whether you have other medical conditions, and which ones. If you are pregnant, other drugs are typically used, such as methyldopa.

ACE inhibitors block a particular enzyme that plays a role in making angiotensin, a hormone which increases blood pressure. Mediations from this group of drugs all have names ending in “-pril,” like ramipril or lisinopril.

Dry cough is the most common side effect of ACE inhibitors, affecting about 5 out of 100 people. In rare cases it can also cause angioedema (swelling in the face, lips and tongue).

ACE inhibitors should not be taken by pregnant women because they can harm the unborn child.

Sartans block the effects of angiotensin, a hormone that increases blood pressure. Their side effects are similar to those of the ACE inhibitors, but coughing is less common with sartans. These medications should not be used during pregnancy either.

Diuretics (also called “water pills”) are drugs that get rid of excess water in the body. They increase urine production in the kidneys, which lowers the pressure in the blood vessels. Their side effects include an increased urge to pass urine and more production of urine. It is best to take this medication in the morning to avoid trips to the toilet during the night.

The minerals potassium and sodium are flushed out of the body with water, which can result in deficiencies. If your body loses too much fluid, potassium or sodium, you may have a dry mouth, weak muscles, or feel confused. To avoid this, it’s important to drink enough, especially on hot days or after doing sports. Older people who are taking a diuretic should be especially careful in this respect. Diuretics aren't suitable for people who have gout or severe kidney disease.

Diuretics can make the skin mores sensitive to light – so it’s especially important to keep out of too much sunlight. They can also slightly increase blood sugar levels.

Calcium channel blockers (CCBs) expand the blood vessels. This gives the blood more room to flow freely, thereby lowering blood pressure. The possible side effects include facial redness, a slower heartbeat, fluid retention (edema) on the ankles, migraines, gastrointestinal problems and muscle and joint pain.

Some calcium channel blockers aren’t suitable for people who have certain types of heart rhythm disorders or a narrowed aortic valve.

If you do have high blood pressure, your cardiovascular system will have already been working hard for quite some time. If you start taking antihypertensive (blood-pressure-lowering) medication, you may feel somewhat weak at first. It could take a while for your circulation to adjust to the drop in blood pressure.

The other side effects also only occur during the first few days of treatment and then go away on their own. To prevent side effects, you can start taking a low dose and then slowly increase it.

It is important not to jump to conclusions about not tolerating a particular medication. It may just be pure coincidence that you get a headache, for example, after taking your medicine. Just because two things happen at about the same time, it doesn’t necessarily mean that there is a link. So it can be worth sticking with the medication for a little longer.

In studies, about 5 out of 100 people stopped using antihypertensives due to the side effects, so most people cope with them well. But if you really can’t tolerate one medicine, you can try another. Sometimes you need to try out a few different ones so that you can find the right medication, with your doctor’s help.

Some dietary supplements and plant-based products may increase or decrease the effectiveness of antihypertensive medication. To avoid these kinds of drug interactions, it’s best to only take dietary supplements of you really need them and you’ve consulted a doctor.

An adult’s blood pressure is considered to be normal if it is less than 140 over 90 (140/90) mmHg. The goal of treatment is to lower blood pressure under that level. But the exact levels you aim for is a matter of individual consideration. The lower your blood pressure is, the better you can prevent complications. But at the same time, the higher the dose of the medicine is, the greater the risk of side effects will be.

Various aspects need to be considered, including your age and possible interactions with any other medicine you are using. Older and frail people in particular have a higher risk of falling if their blood pressure is lowered too much or if the medication causes side effects, like lightheadedness.

Different medications will be more suitable for different people, depending on various factors. These include the possible side effects and interactions with other medicines that you need to use, as well as any other medical problems you might have like kidney disease, diabetes, coronary artery disease, heart failure, atrial fibrillation or a past stroke.

Many people only have to take one type of medication to successfully lower their blood pressure. Others may also need a second or third medicine. Using a combination of medicines is more effective because each one works in a different way. If you take several antihypertensive medications, it can be a good idea to take one of them in the evening – especially if your blood pressure doesn't dip at night, either.

The effect of the medication can only be reliably assessed if you take it as prescribed by your doctor. A little patience is needed: It might sometimes seem like medication isn’t working if the dose is too low or it hasn't been used for long enough.

If you decide to stop taking medication – for instance due to troubling side effects – or if you sometimes forget to take it, you should be honest with your doctor about it. Then you can consider together whether it would be a good idea to try a different dose or even switch the medication.

Many people find it difficult to take medication regularly over longer periods of time. But there are a number of things you can do to make it easier. The following have proven especially useful:

• Regular doctor’s appointments to discuss new aspects of treatment
• Keeping your medicine schedule as simple as possible
• Packaging or containers with compartments for each day, so it’s obvious if you forget to take your medication