Blood Pressure Medications
Bark More Than Bite

Don’t be reluctant to take blood pressure medications provided you have the right choice for your situation. See the guidelines on this webpage. Here we’ll discuss the pros and cons of five classes of medication that have been shown to be the most effective. The large scientific trials used to gather the necessary evidence are outlined on this sister page Blood Pressure Medication

There are five classes of blood pressure medicines that have been found to be the most effective in reducing morbidity and mortality in hypertension:

  • Thiazide diuretics
  • Beta-blockers
  • ACE inhibitors
  • Angiotensin receptor blockers
  • Calcium channel blockers

Thiazide diuretics

Probably the overall drug of choice of all blood pressure medications. Inexpensive. Work by reducing intra-vascular volume and excreting salt. Extra benefit in inhibiting the normal loss of calcium in older people thereby reducing fractures of the hip. Extra benefit in people with heart failure. Some possible side-effects are sodium and potassium loss, minor increase in cholesterol and glucose, and others. Also elevated uric acid (gout) and lower magnesium. Usually well tolerated.

Beta blockers

There are more than a dozen, all generic names end in -lol. Work by decreasing the release of renin and decreasing the cardiac output and possibly actions on the sympathetic nervous systems. Significant extra benefit in treatment of coronary artery disease, congestive heart failure and arrhythmias. Also useful in glaucoma, migraine, intention tremor, hyperthyroidism and performance anxiety (stage fright). May worsen asthma, emphysema, decompensated CHF, second or third degree heart block. Should use with caution in Type I diabetes (insulin). May cause confusion in the elderly. Occasional depression and cold hands or feet. One of the top 5 or 6 classes of all medication in my opinion.

ACE inhibitors

One of the best blood pressure medications. There are more than ten, all generic names end in -pril. Work by decreasing the conversion of angiotension to angiotension II which is a vasoconstrictor. Extra benefits in reducing non-fatal cardiovascular events and heart attack and left ventricular dysfunction (heart failure). Also good for kidney disease especially diabetics as well as acute MI (heart attack). Possible side effects include dry cough (10 to 20%), renal damage in renovascular hypertension, high potassium and allergic swelling. Not for use in pregnancy.

Angiotensin receptor blockers

Growing class. All generic names end in -sartan. They have an action very similar to the ACE inhibitors and a side effect profile also similar. Their action is in a different part of the angiotensin II conversion process so their effects are additive to that of the ACE inhibitors, that is they can be used in combination. One nice advantage: they do not have the cough side effect of the ACE inhibitors.

Calcium channel blockers

We can divide these into dihydropyridines and the nondihydropyridines. The former would be the best choice. The passage of calcium is blocked resulting in vasodilation and thus lowering blood pressure. May result in compensatory tachycardia (fast heartbeat). Able to control angina symptoms but lack the proven reduction in mortality of the beta blockers. Sometimes cause peripheral edema (fluid swelling).

Doctor’s Practical Guide

It seemed to me that some people had a fear of taking any blood pressure medications because of side effects. This is a reasonable concern but does not justify outright fear. I tried to reassure everyone that very few side effects are severe or irreversible, that most were just the opposite. We take the approach that you try a medication and if a side effect occurs and persists the medication is changed. Many times no significant side effect is present. Almost always a suitable agent can be found.

It stands to reason that if a company has a drug that causes everyone side effects they might as well not even try to bring it on the market, nobody would take it. Also if an occasional side effect is severe it would not make sense to market it because everyone would be afraid, including the doctors. Unfortunately something bad can get through despite everyone’s best efforts.

When you balance what happens to you with unchecked hypertension against the perils of taking some of our high blood pressure medications the answer is easy. You are much better served by working with your doctor to find the combination of medicines that is best for you.

What I like even better is making the life-style changes that lower blood pressure with no risk whatsoever. These can eliminate the problem altogether or make it much easier to treat. See this page Lower Blood Pressure

Let’s also remember that your elevation could easily be false and that the only way to really know your true blood pressure is to take it yourself. See how and why at How To Take Blood Pressure

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