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Blood Pressure Medications: Understanding Your Options

Which med you take may depend on your specific risk factors.

Having high blood pressure (a.k.a. hypertension) doesn’t necessarily mean you’ll be need to take daily pills for the rest of your life. You might be able to lower your blood pressure naturally with certain lifestyle tweaks for a healthier heart or diet changes, like following the DASH diet for lower blood pressure.

If lifestyle changes don’t reverse your blood pressure, or if your BP is too high for lifestyle changes alone, then medication is the likely next step. “If your blood pressure is very, very high, you likely are going to have a doctor suggest you start a blood pressure medication right away,” says Rachel Bond, MD, cardiologist at Lenox Hill Hospital. (Learn what blood pressure numbers mean here.)

Patients have a variety of medications options to choose from. Here are common medications to lower blood pressure, according to Dr. Bond.

  • Diuretics help reduce blood pressure by releasing sodium and fluid from the body.
  • Angiotensin II receptor blockers block a chemical (angiotensin) that causes the arteries to restrict, according to the American Heart Association (AHA). Preventing the arteries from restricting improves blood circulation, thus lowering blood pressure.
  • ACE inhibitors help the body produce less angiotensin, thus relaxing the arteries and improving blood pressure levels.
  • Calcium channel blockers keep calcium out of the smooth heart and artery muscles. Calcium causes stronger, harder muscle contractions; blocking calcium from these muscle cells helps keep blood vessels more relaxed, according to AHA.
  • Beta blockers lower heart rate and reduces how much blood the heart outputs, which helps lower blood pressure.
  • Alpha blockers help relax the arteries by reducing their resistance.
  • Vasodilators prompt the blood vessels to relax and dilate, which improves blood flow.

“When we’re making the decision on what to use to treat a patient’s blood pressure, we very much rely on their [heart disease] risk factors,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. For example, patients with heart failure may benefit from an ACE inhibitor or an angiotensin receptor blocker, while those with angina might benefit from a calcium channel blocker, according to Dr. Weisfelner Bloom.

“In general, we try to start with one medication and maximize that medication, but we often find that that’s not enough,” says Dr. Weisfelner Bloom. Your doctor may prescribe a second or third medication if your first option isn’t effectively lowering blood pressure (despite taking them as prescribed).

After starting a medication, your doc will ask you to come back after about four weeks. In addition to checking your blood pressure, your doctor can also do blood work to see how well your body is tolerating the medication. This is also an opportunity for you to bring up any concerns regarding side effects.

“It’s important for patients to know that any medication can potentially give you side effects,” says Dr. Weisfelner Bloom. “If there’s something specifically you’re concerned about or you’re not feeling well with your medication, go talk to your doctor… [We] have many choices when it comes to blood pressure medicines, and if something’s not working, your doctor can switch you to something else.”

Rachel Bond, MD

This video features information from Rachel Bond, MD. Dr. Bond is a cardiologist and associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital and an assistant professor of cardiology at Hofstra Northwell School of Medicine.

Michelle Weisfelner Bloom, MD

This video features information from Michelle Weisfelner Bloom, MD. Dr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.

Duration: 2:44. Last Updated On: April 3, 2018, 2:31 p.m.
Reviewed by: Dr Mera Goodman, . Review date: March 29, 2018
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