Health Education

Blood pressure treatment and medications

Cropped SingleCare logo By | November 6, 2019
Medically reviewed by Michael L. Davis, MD

What is blood pressure? | Blood pressure diagnosis | Blood pressure treatment options | Blood pressure medications | Best blood pressure medications | Side effects of blood pressure | Blood pressure home remedies | FAQ | Resources

What is blood pressure?

The term blood pressure refers to the pressure of your blood as it travels through your body. The measurement for blood pressure contains two numbers, for example, 120/80 mm Hg. The first number, 120,  is the systolic and measures the pressure pushing the blood from your heart. The second number, called diastolic, measures the blood pressure when your heart is at rest in between beats.

For an adult, normal blood pressure is below 120/80, according to the National Institutes of Health (NIH). If your blood pressure is above that, you should review lifestyle changes and medication with your doctor as this can be dangerous to your health.

About 32 percent of American adults (75 million) have high blood pressure, called hypertension, according to the Centers for Disease Control and Prevention (CDC) and one in three adults have prehypertension, which is blood pressure that is higher than normal but not yet in the “high  blood pressure range.” Only a little over half of the people with high blood pressure have their condition under control.

The American Heart Association (AHA) provides ranges explaining the different stages of blood pressure:

  • Low blood pressure: no specific number, but causing fatigue, dizziness, etc.
  • Normal: Less than 120 and less than 80
  • Elevated (prehypertension): 120-129 and less than 80
  • Hypertension, stage 1: 130-139 and/or 80-89
  • Hypertension, stage 2: 140 or higher and/or 90 or higher
  • Hypertension crisis: 180 or higher and/or higher than 120

Blood pressure diagnosis

Risk factors for high blood pressure include: smoking, eating foods high in sodium and low in potassium, not enough physical activity, obesity, diabetes, and drinking too much alcohol according to the CDC.  Your risk increases with age; two-thirds of people aged 60 and above are affected by hypertension, according to the NIH.

Chronic hypertension can lead to several health conditions, according to the AHA. These include:

  • Heart attack
  • Stroke
  • Heart failure
  • Kidney disease or failure
  • Vision loss
  • Sexual dysfunction
  • Angina
  • Peripheral artery disease

There are often no warning signs or symptoms of hypertension. It is called the silent killer. However, extremely high blood pressure can cause headaches, confusion, vision problems, chest pain, difficulty breathing, blood in your urine, and/or pounding in your chest.

Low blood pressure can cause dizziness and fainting. It can be caused by dehydration, sudden loss of blood, severe infection, and heart attack, according to the U.S. National Library of Medicine.

Many people discover they have blood pressure issues during a doctor’s visit when blood pressure levels are taken using a blood pressure cuff. However, your doctor might also order laboratory tests to determine if there is organ or tissue damage and to look for additional health risks. These tests include urinalysis, blood cell count, and blood chemistry. Blood chemistry tests include potassium, sodium, creatinine, fasting glucose, total cholesterol, HDL cholesterol. Your doctor might also request an ECG (electrocardiogram) to detect heart problems, according to the U.S. National Library of Medicine.

Preparing for your appointment

Blood pressure issues, especially hypertension, are frequently noticed during a routine office visit or while being treated for a different condition. When a physician sees elevated blood pressure, they might ask questions such as:

  • What were you doing right before you came to the office?
  • Are you on medications? Which ones?
  • How much exercise do you get regularly?
  • What is your typical diet?

Your healthcare provider might also ask about your medical history and other health conditions, especially diabetes and high cholesterol. The doctor might order laboratory tests to determine if hypertension has caused any other health issues. Based on these results, your physician might refer you to a specialist such as a cardiologist, nephrologist, or neurologist.

When diagnosed with hypertension, you will probably have numerous questions and concerns. Some questions to ask your doctor include:

  • What do the blood pressure numbers mean?
  • What is healthy blood pressure?
  • What changes can I make to improve my blood pressure?
  • How often should I check my blood pressure?
  • Should I use a home blood pressure monitor? What type?
  • Will I need to take blood pressure medication? How long will I need to take it?
  • What are the types of medications? What are the side effects?
  • What happens if I forget to take a dose?

Blood pressure treatment options

There is no cure for hypertension. However, it can be managed through heart-healthy lifestyle changes and high blood pressure medication. For some people, lifestyle changes alone are enough. Lifestyle changes for high blood pressure include:

  • Quitting smoking
  • Losing weight
  • Eating a healthy diet
  • Exercising daily
  • Reducing sodium intake
  • Limiting alcohol consumption

High blood pressure medications

The seven most common types of blood pressure drugs, according to the NIH are:

Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors are a type of vasodilator that blocks the production of angiotensin II, a hormone that causes blood vessels to narrow. Common side effects of ACE inhibitors include cough, elevated potassium levels, dizziness, headache, weakness, rash, chest pain, increased uric acid, and sun sensitivity. When taking vasodilators, you may need to follow a special diet. Ask your doctor for information on what your diet should include. Some common ACE inhibitors include:

  • Lotensin (benazepril)
  • Vasotec, Epaned (enalapril)
  • Prinivil, Zestril, Qbrelis (lisinopril)
  • Accupril (quinapril)
  • Altace (ramipril)
  • Mavik (trandolapril)
  • Capoten (captopril)
  • Monopril (fosinopril)
  • Univasc (moexipril)
  • Aceon (Perindopril)

Angiotensin II receptor blockers (ARBs): ARBs also target the angiotensin II hormone, stopping it from binding with receptors in the blood vessels. This medication helps relax your veins and arteries to lower blood pressure and make it easier for your heart to pump blood. Some people experience side effects, such as dizziness, increased potassium levels, and swelling of the skin. Some of the common ARBs include:

  • Edarbi (azilsartan)
  • Atacand (candesartan)
  • Teveten (eprosartan)
  • Avapro (irbesartan)
  • Cozaar (losartan)
  • Diovan (valsartan)
  • Benicar (olmesartan)
  • Micardis (telmisartan)

Calcium channel blockers: These keep calcium from entering the muscle cells of your heart and blood vessels, allowing blood vessels to relax, making it easier for your heart to pump blood. Side effects can include constipation, dizziness, palpitations, fatigue, flushing, headache, nausea, rash, and swelling in feet and lower legs. Common calcium channel blockers include:

  • Norvasc (amlodipine)
  • Cardizem, Tiazac (diltiazem)
  • Plendil (felodipine)
  • Dynacirc (isradipine)
  • Cardene SR (nicardipine)
  • Adalat CC, Procardia (nifedipine)
  • Sular (nisoldipine)
  • Calan, Verelan (verapamil)
  • Lotrel (amlodipine and benazepril)

Diuretics (water or fluid pills): These work by flushing excess sodium from your body and reducing the amount of fluid in your blood. Diuretics are often combined with other high blood pressure medicines. Combining medication often allows lower doses and, therefore, less potential for side effects. Side effects can include dizziness, headaches, dehydration, muscle cramps, joint disorders, and impotence. Common diuretics used for hypertension include:

  • Diuril (chlorothiazide)
  • Thialitone, Hygroton (chlorthalidone)
  • Microzide (hydrochlorothiazide)
  • Lozol (indapamide)
  • Zaroxolyn (metolazone)
  • Lasix (furosemide)
  • Demadex (torsemide)
  • Bumetanide (bumex)

Beta-blockers: These reduce the heart rate, which reduces the heart’s workload, which lowers blood pressure. Common side effects include insomnia, cold hands and feet, tiredness, and impotence. Some of the beta-blockers commonly used to treat high blood pressure include:

  • Sectral (acebutolol)
  • Tenormin (atenolol)
  • Kerlone (betaxolol)
  • Zebeta (bisoprolol fumarate)
  • Lopressor (metoprolol tartrate)
  • Toprol-XL (metoprolol succinate)
  • Corgard (nadolol)
  • Visken (pindolol)
  • Inderal (propranolol hydrochloride)
  • Coreg (carvedilol)
  • Trandate, Normodyne (labetalol)
  • Bystolic (nebivolol)
  • Betapace (sotalol)

Alpha-blockers: Alpha-blockers relax the muscle tone of the vascular walls, lowering blood pressure. Side effects include palpitations, dizziness, and a drop in blood pressure when standing up. Some of these medications include:

  • Cardura (doxazosin mesylate)
  • Minipress (prazosin)
  • Hytrin (terazosin hydrochloride)

Central agonists: Decrease the ability of blood vessels to contract, which leads to lower blood pressure. Side effects can include a drop in blood pressure when standing or walking, drowsiness, sluggishness, dry mouth, impotence, and constipation. Some common central agonists used for hypertension include:

  • Aldomet (alpha methyldopa)
  • Catapres (clonidine hydrochloride)
  • Tenex (guanfacine)

Low blood pressure medications

Many people with low blood pressure do not require prescriptions. Lifestyle and diet changes will increase blood pressure. However, some people do take medication to help increase their blood pressure. There are two medications:

Fludrocortisone acetate: This medication works to promote sodium retention in the kidneys, which in turn causes fluid retention, which can increase blood pressure according to the U.S. National Library of Science. Side effects can include upset stomach, vomiting, headache, dizziness, insomnia, restlessness, anxiety, increased hair growth, and irregular or absent menstrual periods.

Midodrine: This medication works by activating receptors on small arteries and veins, which increases blood pressure. It works to reduce orthostatic hypotension, which is a sudden fall in blood pressure when someone stands up according to the U.S. National Library of Science. Common side effects include numbness, tingling, itching of the scalp, chills, urination issues, rash, and stomach pain.

What are the best medications for blood pressure?

There are many different choices for the treatment of hypertension and low blood pressure, and there is no “best” medication. What works for one person might not work for another. Everyone reacts differently to medicines, and it sometimes takes time to find the right drug or combination of drugs and the right dosage for you. Your doctor will take your medical conditions, medical history, and other medication you are taking into consideration when suggesting a treatment for you.  

*many of these medications require an initial low dose and gradual increase in dosage until maintenance level is achieved.

Drug name (generic) Drug type Hyper- or hypotension Methods of use Standard dosage Common side effects
Lotensin (benazepril) ACE inhibitor Hypertension Tablet 20 – 40 mg/day

 

Headache, dizziness
Vasotec, Epaned (enalapril) ACE inhibitor Hypertension Tablet 10 – 40 mg/day Blurred vision, confusion, dizziness
Prinivil, Zestril, Qbrelis (lisinopril) ACE inhibitor Hypertension Tablet 20 – 40 mg/ day Dizziness, hypotension, headache
Plendil (felodipine)

 

Calcium channel blockers Hypertension Tablet Up to 10 mg/day Bloating, weight gain, tingling in hands and feet
Microzide (hydrochlorothiazide) Diuretic Hypertension Capsule Up to 50 mg/day Weakness, hypotension, blurred vision
Sectral (acebutolol) Beta-blocker Hypertension Capsule Up to 800 mg/day Dizziness, drowsiness, slow heartbeat
Hytrin (terazosin) Alpha-blocker Hypertension Tablet

Capsule

Up to 10 mg/day Dizziness, headache, fatigue
Aldomet (methyldopa) Central agonists Hypertension Tablet 100 mg/day Swelling of feet or lower legs
Catapres (clonidine hydrochloride) Central agonists Hypertension Tablet

Patch

0.2 – 0.6 mg/day Constipation
Fludrocortisone acetate Mineralocorticoids Hypotension Tablet 0.1 – 0.2 mg/day Edema, cardiac enlargement, congestive heart failure

Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.

What are the common side effects of blood pressure medications?

As with all medications, those used to treat blood pressure might cause side effects. It is essential to talk with your physician before starting a medicine about the potential side effects and which would require immediate medical attention. Not everyone experiences side effects and sometimes they go away after a while as your body adjusts to the medication. However, if side effects are interfering with your ability to carry out daily activities or do not go away after a few weeks, you should speak with a medical professional.

The following are some of the common side effects of the different types of medications for blood pressure issues. It is not a complete list.

ACE inhibitors

  • Persistent cough
  • Elevated potassium levels
  • Dizziness
  • Headache
  • Weakness
  • Rash
  • Chest pain
  • Increased uric acid
  • Sun sensitivity

Angiotensin II receptor blockers (ARBs)

  • Dizziness
  • Increased potassium levels
  • Swelling of skins

Calcium channel blockers

  • Constipation
  • Dizziness
  • Heart palpitations
  • Fatigue
  • Flushing
  • Headache
  • Nausea
  • Rash
  • Swelling in feet and lower legs

Diuretics

  • Dizziness
  • Headaches
  • Dehydration
  • Muscle cramps
  • Joint disorders
  • Impotence

Beta-blockers

  • Insomnia
  • Cold hands and feet
  • Tiredness
  • Impotence

Alpha-blockers

  • Heart palpitations
  • Dizziness
  • A drop in blood pressure when first standing up

Central agonists

  • A drop in blood pressure when standing or walking
  • Drowsiness
  • Sluggishness
  • Dry mouth
  • Impotence
  • Constipation

How can I get off my blood pressure medication?

If you are taking blood pressure medication for either high or low blood pressure, it is essential to talk with your doctor before stopping it. Suddenly discontinuing, or even reducing your dosage, can be dangerous. If you have hypertension, stopping your medication can cause a spike in blood pressure. If you have low blood pressure, stopping can cause your blood pressure to drop drastically. Both situations can be life-threatening. If you do want to discontinue or reduce your medication, work with your doctor to gradually reduce the dosage.

Some people need to take medication for the rest of their life to keep their blood pressure stabilized. Others find that lifestyle changes help them reduce or eliminate daily medication for hyper- or hypotension. Lifestyle changes include:

  • Exercising regularly: Regular exercise can help lower blood pressure according to a study completed in 2016. Researchers found that there was a significant reduction of blood pressure in the hours after exercise, especially when the activity was a preventative measure against hypertension.
  • Lose weight: Being overweight, especially if you carry weight in your belly, is linked to increased blood pressure, according to the American College of Cardiology. A healthy waist size for women is less than 35 inches, and for men, it is less than 40 inches.
  • Reduce sodium intake: The Centers for Disease Control and Prevention recommends that you consume less than 2,300 mg of sodium per day. The average person living in the U.S., however, intakes more than 3,400 mg per day. Research has linked higher levels of sodium intake to higher blood pressure. Reducing your salt intake can lower your risk.

Natural blood pressure remedies

In addition to general lifestyle changes, there are specific steps you can take to improve your blood pressure naturally

Dash diet

Dietary Approaches to Stop Hypertension (DASH) is an eating plan that has been found to lower blood pressure, according to the National Heart, Lung, and Blood Institute. It is also consistent with recommendations to prevent osteoporosis, cancer, heart disease, stroke, and diabetes. It emphasizes eating vegetables, fruits, and whole grains and includes foods with healthier fats such as fish, poultry, beans, nuts, and vegetable oils. When following the DASH diet, you should limit foods high in saturated fats and trans fats, high in sodium, and sweets, including sugar-sweetened beverages. The DASH diet teaches focus on portion sizes while giving a large variety of foods.

Vitamins, minerals, and supplements

Several vitamins and minerals are essential to maintaining healthy blood pressure, according to Harvard Health. These include:

Potassium: This mineral is vital for muscle function, including the muscles around the blood vessels. Potassium helps relax the walls of blood vessels, which can lower blood pressure. You can find potassium in foods such as prunes, apricots, sweet potatoes, and lima beans. However, it may be hard to get enough potassium through foods alone, especially if you take a diuretic, which removes potassium from your body through increased urine production. Talk to your doctor about whether you should consider a potassium supplement, and if so, what strength, as too much potassium can be dangerous.

Magnesium: This mineral also helps to relax blood vessels and can lower blood pressure. As with potassium, when you are on diuretics, magnesium is sometimes removed from your body. You can find magnesium in dark, leafy vegetables, unrefined grains, and legumes. Talk to your doctor before starting magnesium supplements, as too much magnesium can cause diarrhea or even cardiac arrest.

Calcium: Calcium helps blood vessels constrict and relax as needed, so it is essential to have calcium in your diet. Calcium supplements are controversial as some studies indicate that supplements can increase your risk of developing heart disease. It is best to get your calcium through your diet.

Frequently asked questions about blood pressure

How does blood pressure medication work?

There are different types of blood pressure medications, which work in different ways.

  • ACE inhibitors and Angiotensin II receptor blockers work to reduce the angiotensin II hormone, allowing blood vessels to relax, which lowers blood pressure.
  • Diuretics work by increasing urine production, removing salt and water in your body, which decreases the volume of your blood, lowering blood pressure.
  • Beta-blockers slow down your heartbeat and decrease the strength of your pulse meaning that blood is pumped through the blood vessels with less force, causing lower blood pressure.
  • Calcium channel blockers relax the muscles that surround blood vessels, causing the blood vessels to become larger, meaning that there is more space for blood flow, which lowers blood pressure. Some of these medications also decrease the speed and strength of heartbeats.

What are the safest blood pressure medications?

Medications currently on the market have gone through rigorous testing and assessment, and the FDA has deemed them safe. However, some drugs have been recalled, and a study in 2018 found that alpha-blockers and alpha-2 agonists were linked with variability in blood pressure levels. The researchers believe these medications should not be used to treat high blood pressure.

Which blood pressure medications are recalled?

Certain angiotensin II receptor blockers, such as Diovan and Cozaar, containing valsartan, losartan, or irbesartan were recalled in March of 2019 due to the presence of N-Nitrosodiethylamine (NDEA) or N-Nitrosodimethylamine (NDMA) in some of the batches. The issue has since been fixed. NDEA and NDMA are industrial contaminants that can cause cancer in some people. You can see a complete list of FDA recalls on the FDA site.

What happens in an overdose of blood pressure medication? Can it cause death?

Too much blood pressure medication could affect the cardiovascular, nervous, digestive, and respiratory systems. Each type of blood pressure medicine will cause different symptoms if you take more than prescribed. Generally, taking too much medication for high blood pressure risks causing lightheadedness and dizziness, and a severe drop in blood pressure can cause passing out and could even be fatal. If taking medication for low blood pressure, your blood pressure could spike to dangerous levels. The best course of action would be to seek medical advice immediately or call 911 for assistance.

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