Hypertension treatments & medications

Hypertension, or high blood pressure, is often called the “silent killer”, since it can lead to serious complications without showing any symptoms. It's caused by increased pressure on the arterial walls over time. Without treatment, it can lead to problems like heart attack, stroke, and kidney disease, among others. Although there’s no cure, it can usually be controlled with lifestyle changes, especially alongside medication. There are various types of antihypertensives that can be used alone or in combination.

How is hypertension diagnosed?

Hypertension is typically discovered during a visit with a healthcare provider. Blood pressure is a vital sign that can be easily measured with a blood pressure cuff. Once there’s a trend of higher readings with each visit, a healthcare provider may take a closer look. They might evaluate the following:

• Medical history: A healthcare provider will ask about diet, other medical conditions, and lifestyle habits, such as smoking and drinking alcohol. 

• Blood and urine tests: These lab tests can help check for abnormal levels of cholesterol, blood sugar, potassium, and sodium, which could contribute to high blood pressure.

• An electrocardiogram (ECG): This test can help detect problems with the heart, such as abnormal heart rhythms.

Blood pressure is written as two numbers, systolic over diastolic; a reading below 120/80 mm Hg is normal, while 130/80 mm Hg or higher is considered high. Your healthcare provider may ask you to track your blood pressure readings with a home blood pressure monitor to confirm the diagnosis and monitor your progress.

Hypertension treatment options

There is no cure for hypertension. Treatments for hypertension focus on lowering and keeping blood pressure at a healthy range. For many people, lifestyle changes like eating a balanced diet, exercising regularly, and quitting smoking are sufficient. However, medications may also be recommended depending on how severe the hypertension is. Stage 1 hypertension is often started on a single drug, while stage 2 usually needs two. Before prescribing, a healthcare provider may also look at other health conditions a person has and how they respond to medication.

Types of hypertension medication

Several drug classes can lower blood pressure in different ways, and many people end up taking more than one. Brand names are for reference, as not every drug is sold under a brand.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors are a class of vasodilators that block the production of angiotensin II, a hormone that narrows blood vessels. These medications are usually a first-line option, especially for people who have diabetes or chronic kidney disease. Examples include Zestril (lisinopril), Lotensin (benazepril), and Altace (ramipril).

Angiotensin receptor blockers (ARBs)

ARBs also target the hormone angiotensin II, preventing it from binding to receptors in blood vessels, which helps relax blood vessels and lower blood pressure. Since they don’t often cause the dry cough associated with ACE inhibitors, ARBs are a common alternative. Examples include Cozaar (losartan), Diovan (valsartan), and Benicar (olmesartan).

Calcium channel blockers

Calcium channel blockers keep calcium from entering the muscle cells of your heart and blood vessels, allowing blood vessels to relax and making it easier for your heart to pump blood. They come in both short-acting and extended-release forms. Common options include Norvasc (amlodipine) and Cardizem (diltiazem).

Diuretics

Also known as water pills, diuretics work by flushing excess sodium through the urine and reducing the amount of fluid in your body. Diuretics are often combined with other high blood pressure medicines. Thiazide diuretics like Microzide (hydrochlorothiazide) and Hygroton (chlorthalidone) are used to treat high blood pressure, while loop diuretics like Lasix (furosemide) may be used in certain cases.

Beta blockers

Beta blockers slow the heart rate and reduce the heart's workload. They are no longer a first-line choice for uncomplicated hypertension, but are still used when there is another reason for them, such as heart failure. Examples include Toprol XL (metoprolol succinate) and Coreg (carvedilol).

Other options

If blood pressure remains uncontrolled, a healthcare provider may recommend an alpha blocker such as Cardura (doxazosin) or a central alpha-2 agonist such as Catapres (clonidine). Combination medications like Hyzaar (losartan and hydrochlorothiazide) can make it easier to track treatment. 

Over-the-counter hypertension medicine

No over-the-counter medicines are approved to treat high blood pressure. Some OTC products may even raise blood pressure, including NSAID pain relievers such as ibuprofen and naproxen, as well as decongestants containing pseudoephedrine. If you have hypertension, ask a pharmacist before taking them. 

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