The Basics of Medication for High Blood Pressure 
Types and Uses

April 10, 2023

Hypertension, or high blood pressure, is often referred to as the “silent killer” because of its tendency to go undetected without a medical diagnosis. In the United States, nearly half of all adults have hypertension or take medication for hypertension. Uncontrolled high blood pressure can put you at risk for premature death from causes like heart disease, heart attack or stroke, so it's important for you to know your numbers and whether you are at risk.

If you’ve been diagnosed with or are at risk for developing hypertension, your doctor may discuss medications available to help get your blood pressure under control. Philadelphia College of Osteopathic Medicine's (PCOM) Peter Bidey, DO, MSEd, vice-chair in the Department of Family Medicine and assistant professor in the Doctor of Osteopathic Medicine (DO) program, explains the most common types of blood pressure medications and under what circumstances they're typically prescribed.

Types of Blood Pressure Medications

1. Diuretics

Diuretics are medications that clinicians prescribe to decrease your blood pressure by eliminating certain salts and water from your body in the kidney. They are an effective first-line medication therapy for most patients with high blood pressure. They are very easy to use and often only need to be taken once per day. Although they are quite effective, sometimes you can lose too many of the salts (sodium, potassium, etc.) and even the water in your body and this can lead to issues with your kidneys, electrolytes and/or dehydration. Likewise, as the name implies, these medications can also make you go to the bathroom a little more. The best way to prevent these side effects is to speak with your healthcare provider for regular follow-ups and healthy eating habits.

2. Beta-blockers

Beta-blockers are medications that clinicians prescribe to decrease your blood pressure by interacting with the beta-adrenergic receptors in your body. They work by blocking some of the effects hormones like epinephrine have in your body and, in turn, decrease your heart rate and forces on your heart and vessels. They are incredibly important for patients who have high blood pressure as well as a history of heart attacks or even congestive heart failure, giving them the term “cardioprotective.” They are often taken once or twice a day. One of the most common side effects of decreasing your blood pressure with this type of medication is a lowering of your heart rate and blood pressure too low, causing dizziness, as well as sometimes hair loss and fatigue.

3. ACE inhibitors

ACE inhibitors are medications that clinicians prescribe to decrease your blood pressure by blocking the production of a substance called angiotensin II. This substance is responsible for increasing the “tension” in your blood vessels and, in turn, decreasing your blood pressure. These medications are particularly important for diabetic patients who have high blood pressure and are sometimes called “kidney protective.” The majority of these medications are usually taken once per day. The most common side effect is a dry cough. Likewise, because they work primarily with the kidney, your kidney function and electrolytes are usually monitored when first taking this type of medication. Additionally, in very rare cases these medications can cause angioedema – a swelling of the tongue, face and lips.

4. Angiotensin II receptor blockers

Angiotensin II receptor blockers (ARBs) work very similarly to ACE inhibitors, but instead of blocking the production of angiotensin II, they block the action of it. They have the same effect as ACE inhibitors and the frequency per day is very similar. Their use, especially in diabetics, and side effects are also the same except that, due to a different mechanism of action, they usually do not cause the same dry cough as ACE inhibitors.

5. Calcium channel blockers

Calcium channel blockers work exactly as their name states; they block calcium from entering  cells in your heart and arteries. When calcium does enter into these areas, it usually causes an increase in contractions, but by decreasing this action, calcium channel blockers help lower your blood pressure. These medications are usually taken once or twice per day and certain types can affect your heart rate and rhythm. These are very effective medications and, as with thiazide diuretics, are first-line medication therapies for most patients with high blood pressure. They are usually well tolerated in patients and without the side effects of dizziness, fast heart rates, headaches and swelling in your feet.

6. Alpha blockers

Alpha blockers, similar to Beta-blockers, alter hormonal effects, but in this case, norepinephrine, from causing constriction of your blood vessels. However, due to the effect on muscles and constriction, these medications can also help improve urine flow in patients with prostate issues. Medications in this group can be short or long-acting, so sometimes you may need to take them multiple times a day. Additionally, due to their mechanism of action, these medications are not often used as a first-line medication for people with only high blood pressure. When first starting this medication, as with most other blood pressure medications, you may experience issues with low blood pressure as well as dizziness, especially when going from laying down or sitting to standing.

Before starting any new medication, talk with your doctor about the risks and benefits of each to decide what's best for you. Taking medication, along with diet and exercise, can help reduce your risk factors for cardiovascular events and other health problems.

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