High blood pressure, which affects nearly half of all U.S. adults, occurs when the force of the blood flowing through your arteries is consistently too high, forcing the heart to work harder. Over time, high blood pressure can damage major organs including the heart, brain, kidneys, and eyes and lead to life-threatening issues like heart disease, heart attack, and stroke.
With effective treatment, including both heart-healthy lifestyle habits and prescription blood pressure medications, you can control your blood pressure and live an active life. There are a variety of blood pressure medications, and it may take some time for you and your doctor to determine the best treatment for your needs. The good news is that with so many available and effective medications, you’re likely to find one that’s right for you. Read on to learn more about the most common classes of blood pressure medications and their side effects.
Diuretics
Diuretics lower blood pressure by helping the body get rid of excess sodium and water, reducing the volume of fluid in blood vessels. They are often a frontline treatment for high blood pressure, as research studies have found them to be one of the most effective blood pressure medication classes at preventing stroke and heart attack fatalities.
Diuretics commonly used to treat high blood pressure include:
Chlorthalidone (Thalitone®, Tenoretic®, and Clorpres®)
Hydrochlorothiazide (HydroDiuril®, Microzide®, and Esidrix®)
Indapamide (Lozol®)
Common side effects of diuretics include dehydration, thirst, low sodium levels, headaches, and dizziness. In some cases, drinking more fluids isn’t enough to treat dehydration. Contact your doctor if you experience severe thirst, mouth dryness, or constipation; if your urine is a deep yellow; or if you have a bad headache. Taking multiple medications may exacerbate these side effects. To minimize medication interactions, speak with your doctor about the ideal timing of doses for each medication.
Some diuretics decrease your potassium levels, in which case you may experience weakness, leg cramps, or fatigue. Eating potassium-rich foods can help combat these side effects. Consult with your doctor about taking potassium supplements if you experience any of these symptoms.
Diuretics may increase blood sugar levels in people with diabetes. Adjusting your diet or the dosages of your diabetes medication(s) often addresses this issue. Learn more about how Alto can support your diabetes treatment.
Beta blockers
Beta blockers cause the heart to beat more slowly and less forcefully, lowering your blood pressure. They also help improve overall blood flow by opening up your veins and arteries.
Beta blockers commonly used to treat high blood pressure include:
Atenolol (Tenormin®)
Bisoprolol (Zebeta®)
Metoprolol tartrate (Lopressor®)
Metoprolol succinate (Toprol-XL®)
Propranolol (Inderal®)
Solotol (Betapace®)
Common side effects from taking beta blockers include:
Cold hands and feet
Fatigue
Weight gain
Less common side effects include:
Depression
Shortness of breath
Insomnia
Beta blockers may block signs of low blood sugar such as a rapid heart rate in people with diabetes. If you have diabetes and take insulin, it’s important to check blood sugar levels often while taking beta blockers.
These medications may also affect your cholesterol and triglyceride levels. Most often, they cause a modest increase in triglycerides, a type of fat found in your blood, and a slight decrease in HDL (high-density lipoprotein), or “good” cholesterol. These changes are usually temporary.
Beta blockers aren’t typically used by people with asthma, as they may trigger severe asthma attacks. Abruptly stopping use of beta-blockers may increase your risk of a heart attack or other health complications, especially if you have been taking the medication for a long time. Consult with your healthcare provider about the potential risks and benefits of treating your hypertension with beta-blockers.
ACE inhibitors
ACE inhibitors lower blood pressure by blocking production of a hormone called angiotensin II, which causes blood vessels to narrow. These medications help constricted blood vessels expand so that more blood can flow through.
ACE inhibitors commonly used to treat high blood pressure include:
Benazepril (Lotensin®)
Enalapril (Vasotec®)
Fosinopril (Monopril®)
Lisinopril (Prinivil®, Zestril®)
Ramipril (Altace®)
A chronic dry, hacking cough is one of the most common side effects of ACE inhibitors, affecting as many as 35% of people who take these medications. Researchers aren’t entirely sure why some people experience this side effect and not others, but the following factors may contribute to it:
Gender — women tend to be more susceptible
Bronchial hyperreactivity (BHR)
Being a non-smoker
History of asthma
Cough reflex sensitivity
Studies have found that a combination of two or more of the factors above is needed to produce the side effect.
Cough medicines typically aren’t effective at treating an ACE inhibitor-related cough. In some cases, this side effect may improve on its own. If you are experiencing a cough from taking ACE inhibitors, the best course of action is to discuss the pros and cons of switching to another medication with your doctor.
Additional possible side effects of ACE inhibitors include:
Skin rash
Loss of taste
Kidney damage in rare cases
ACE inhibitors can harm both mother and baby during pregnancy. If you’re taking an ACE inhibitor and think you might be pregnant, speak with your doctor immediately.
Angiotensin II receptor blockers
Like ACE inhibitors, angiotensin II receptor blockers (ARBs) also protect blood vessels from the hormone angiotensin II. Angiotensin II must bind with a receptor site to constrict blood vessels. ARBs block the receptors to prevent blood vessels from tightening, which lowers blood pressure.
ARBs commonly used to treat high blood pressure include:
Candesartan (Atacand®)
Irbesartan (Avapro®)
Losartan (Cozaar®)
Telmisartan (Micardis®)
Valsartan (Diovan®)
Common side effects of ARBs include:
Headaches
Fainting, dizziness, and/or fatigue
Respiratory symptoms
Vomiting and diarrhea
Back pain
Leg swelling
High potassium levels
ARBs may produce harmful interactions with other medications. This medication class should not be taken with an ACE inhibitor, as the combination can lead to a greater risk for low blood pressure, kidney damage, and high potassium levels. Speak with your doctor before taking painkillers like ibuprofen or naproxen, as these medications may interact with ARBs to increase your potassium levels.
ARBs are not safe to take during pregnancy, as they can severely harm a developing fetus. If you think you might be pregnant, consult with your doctor immediately.
Calcium channel blockers
Calcium channel blockers prevent calcium from entering the smooth muscle cells of the heart and blood vessels. Decreasing the calcium in these cells makes the heart beat with less force, opening up narrowed blood vessels and lowering blood pressure.
Calcium channel blockers commonly used to treat high blood pressure include:
Amlodipine (Norvasc®, Lotrel®)
Diltiazem (Cardizem CD®, Cardizem SR®, Dilacor XR®, Tiazac®)
Nifedipine (Adalat CC®, Procardia XL®)
Verapamil (Calan SR®, Covera HS®, Isoptin SR®, Verelan®)
Possible side effects of calcium channel blockers include:
Palpitations
Swollen ankles
Constipation
Headache
Dizziness
Alpha blockers
The body releases hormones called catecholamines in response to stress. When these hormones bind to parts of cells called alpha-receptors, blood vessels narrow, causing the heart to beat faster and more forcefully. This leads to an increase in blood pressure.
Alpha blockers prevent catecholamines from binding to alpha-receptors so that blood can flow more freely, which also helps the heart beat more normally. This helps control blood pressure.
Alpha blockers commonly used to treat high blood pressure include:
Doxazosin (Cardura®)
Prazosin (Minipress®)
Terazosin (Hytrin®)
Possible side effects of alpha blockers include:
Fast heart rate
Dizziness
A drop in blood pressure when you stand up
Consult your doctor about the potential risks and benefits of taking an alpha blocker. These medications have been known to interact with other medications like beta blockers, calcium channel blockers, and medications for erectile dysfunction, increasing or decreasing their effects. Make sure your doctor is aware of any other medications you take.
Alpha-beta blockers
When combined, alpha blockers and beta blockers prevent catecholamine hormones from binding to both alpha and beta receptors. These medications decrease the constriction of blood vessels and make the heart work less forcefully.
Alpha-beta blockers commonly used to treat high blood pressure include:
Carvedilol (Coreg®)
Labetalol (Normodyne®, Trandate®)
They are often used as an IV drip to treat severely high blood pressure. When used daily, they are primarily taken by people who have congestive heart failure.
The most common side effect of alpha-beta blockers is a drop in blood pressure when you suddenly stand up, which can cause dizziness, lightheadedness, or weakness. To minimize your risk of side effects, your doctor may initially prescribe a low dose and gradually work you up to a higher one. It’s important to follow your doctor’s recommendations carefully.
Central agonists
Central agonists control nerve impulses to prevent blood vessels from constricting and reduce blood pressure.
Central agonists commonly used to treat high blood pressure include:
Methyldopa (Aldomet®)
Clonidine (Catapres®)
Guanfacine (Tenex®)
Side effects vary by individual medications. Alpha methyldopa can lead to a greater drop in blood pressure when you're standing or walking, which may cause you to feel weak or faint. It can also cause drowsiness, mouth dryness, fever, anemia, or impotence in men. Clonidine and guanfacine can cause severe mouth dryness, constipation, or drowsiness.
Abruptly stopping the use of central agonists can lead to an increase in blood pressure. Consult with your doctor about the risks and benefits of taking central agonists, and follow their instructions closely to avoid complications.
Vasodilators
Vasodilators relax the muscles in the walls of blood vessels, which widens blood vessels and allows blood to flow through better. This causes blood pressure to lower.
Vasodilators commonly used to treat high blood pressure include:
Hydralazine (Apresoline®)
Minoxidil (Loniten®)
These medications are typically reserved for cases of severe high blood pressure that are resistant to other treatments. Common side effects include:
Rapid heartbeat
Heart palpitations
Fluid retention
Nausea
Vomiting
Flushing
Headache
Excessive hair growth
Joint pain
Chest pain
Many of these side effects are the result of interactions with other medications. Inform your doctor of any other medications you take, and discuss the potential risks and benefits prior to starting a vasodilator.
The importance of blood pressure screening
Early detection of high blood pressure is critical to avoiding serious long-term health complications. There are not typically any warning signs or symptoms of high blood pressure, so it’s important to get your blood pressure regularly tested.
If your blood pressure is below 120/80 mm Hg, get screened at least once per year. If your blood pressure is consistently above 130/80 mm Hg, consult with your doctor about recommended screening frequency.
Remember that it’s never too early — or too late — to take up heart-healthy lifestyle habits. Staying active, avoiding cigarette smoke, limiting your sodium intake, and proactively managing stress can protect your health for years to come.
Delivering your blood pressure medications on schedule, every time
Alto makes it as simple as possible to follow the treatment your doctor recommends. We offer same-day delivery and medication management tools like reminders and auto refills in our app. Our team of patient care pharmacists is also available to walk you through dosage instructions and answer your questions. Reach out via phone at 1-800-874-5881 or in-app messaging to get started.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
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