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High Blood Pressure Medication Overview

Sometimes blood pressure stays too high even when a person makes these kinds of healthy changes. In that case, it is necessary to add blood pressure mediation to help lower blood pressure.

Blood pressure medications will control your blood pressure but they cannot cure it. You will need to take high blood pressure medicine for a long time.

Blood pressure medications work in different ways to lower blood pressure. Often, two or more drugs work better than one. Some drugs lower blood pressure by removing extra fluid and salt from your body. Others affect blood pressure by slowing down the heartbeat, or by relaxing and widening blood vessels.

Types of High Blood Pressure Medications

Below are the types of medicines used to treat high blood pressure:

  • Diuretics are sometimes called "water pills." They work by helping your kidneys flush excess water and salt from your body. This reduces the amount of fluid in your blood, and your blood pressure goes down. There are different types of diuretics. They are often used along with other high blood pressure medicines and may be combined with another medicine in one pill.
  • Beta blockers help your heart beat slower and with less force. Your heart pumps less blood through the blood vessels, and your blood pressure goes down.
  • Angiotensin converting enzyme (ACE) inhibitors keep your body from making a hormone called angiotensin II, which normally causes blood vessels to narrow. ACE inhibitors prevents this narrowing so your blood pressure goes down.
  • Angiotensin II Receptor Blockers (ARBS) are newer blood pressure drugs that protect your blood vessels from angiotensin II. As a result, the blood vessels relax and become wider, and your blood pressure goes down.
  • Calcium channel blockers (CCBs) keep calcium from entering the muscle cells of your heart and blood vessels. This causes blood vessels to relax, and your blood pressure goes down.
  • Alpha blockers reduce nerve impulses that tighten blood vessels, allowing blood to pass more easily and causing blood pressure to go down.
  • Alpha-beta blockers reduce nerve impulses to blood vessels the same way alpha blockers do, but they also slow the heartbeat, as beta blockers do. As a result, blood pressure goes down.
  • Nervous system inhibitors relax blood vessels by controlling nerve impulses from the brain. This causes blood vessels to become wider and blood pressure to go down.
  • Vasodilators open blood vessels by directly relaxing the muscle in the vessel walls, causing blood pressure to go down.

Selection of the appropriate blood pressure medication is dependent on a patient’s preexisting health and the stage of their hypertension. A general guideline is shown on the next page.

Achieving Blood Pressure Control in Individual Patients

Most patients who are hypertensive will require two or more antihypertensive medications to achieve their blood pressure goals. Addition of a second drug from a different class should be initiated when use of a single drug in adequate doses fails to achieve the blood pressure goal. When blood pressure is more than 20/10 mmHg above goal, consideration should be given to initiating therapy with two drugs, either as separate prescriptions or in fixed-dose combinations. The initiation of drug therapy with more than one agent may increase the likelihood of achieving the blood pressure goal in a more timely fashion, but particular caution is advised in those at risk for orthostatic hypotension, such as patients with diabetes, autonomic dysfunction, and some older persons. Use of generic drugs or combination drugs should be considered to reduce prescription costs.


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