What medications are used to treat high blood pressure?

The major types of medication used to control high blood pressure include:

Thiazide diuretics. These water pills act by removing the excess water and salt from the body. These drugs are the first line for treatment of high blood pressure; they are cheap, effective and have minimal side effects. In the majority of individuals are very effective and should be the first line drugs of choice.

Beta blockers. These medications act by decreasing the work of the heart and dilating (opening) up the blood vessels. They have been around for more than 50 years. Unfortunately, they are not very effective in African Americans but otherwise work in all ethnic groups. The side effects include decreased libido and glucose intolerance.

Angiotensin-converting enzyme (ACE) inhibitors. These drugs have today become the gold standard and are very effective in the treatment of high blood pressure. They also protect the heart and are useful in all groups of patients. They are useful in individuals with diabetes, heart failure or those who have angina (chest pain). They are readily available but some are expensive and do have a tendency to produce a persistent dry cough.

Angiotensin II receptor blockers. These latest medications open up the blood vessels and decrease the blood pressure. However they are very expensive and are not first line treatment. They are to be used in individuals who do not respond to the other drug treatments. Some clueless physicians routinely prescribe these drugs as first line therapy for hypertension.

Calcium channel blockers. These drugs have been around for many years and work well in African Americans. They are very effective in the treatment of blood pressure. They are reasonably priced but should not be used in patients with a weak heart. They do tend to cause swelling in the feet.

Renin inhibitors. These are the latest drugs available to treat blood pressure. They act by inhibiting a chemical (renin) which is known to cause high blood pressure. The new drug, Tekturna (aliskiren) is a renin inhibitor. The drug is very expensive and is not a first line drug. The drug is most effective when used in combination with other drugs.

Alpha blockers. These medications have been around for decades but are rarely used to treat high blood pressure because of their side effects

Central-acting agents. There are some medications which act in the brain to decrease the nerve impulses to the blood vessel. They are quite effective in decreasing blood pressure and widely used (e.g. clonidine, Aldomet)

Vasodilators. There are a variety of medications which can open up narrowed blood vessels and decrease blood pressure. These medications are often used intravenously in the ICU for emergent use in the treatment of hypertension.

Once your blood pressure is under control, your doctor may add aspirin and/or a medication to lower your cholesterol to your regimen to further decrease the risk of a heart attack.

Resistant hypertension

In some cases, high blood pressure may be resistant to a single drug and a combination of 2-3 drugs may be required. Many of these combination therapies are done on a trial and error basis. In some cases, the individual will be referred to a heart specialist who deals with blood pressure treatment.

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