Blood Pressure Medications: Types, Benefits, Risks – Blood pressure is a measure of how much pressure blood exerts against the walls of a person’s arteries. When blood pressure is outside of the normal range, it can lead to serious health complications.
High blood pressure (hypertension) affects an estimated 45% of U.S. adults, reports the National Center for Health Statistics[1]. Meanwhile, low blood pressure (hypotension) affects an additional 5% to 30% of individuals over the age of 50, with people over the age of 70 being at the highest risk, according to research in the Journal of the American College of Cardiology[2].
In some cases, lifestyle changes are sufficient to keep blood pressure under control. However, healthcare providers may prescribe specific pharmacologic therapies to certain individuals. Read on to learn more about common types of blood pressure medications, including what they are, how they work, and questions to ask a healthcare provider before taking them.
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Blood Pressure Medications: When Do Doctors Prescribe Them?
Normal blood pressure for most adults is marked by a systolic reading between 90 and 120 mm/Hg and a diastolic reading between 60 and 80 mm/Hg. Although it’s normal for blood pressure to fluctuate throughout the day, when it consistently varies from this value—either higher or lower—healthcare providers may suggest taking steps to improve it.
In many cases of high blood pressure, lifestyle modifications, such as eating a healthy diet, exercising regularly, and quitting smoking, maybe the first recommended steps. If lifestyle changes aren’t enough, a healthcare provider may recommend the use of medications.
“Medications [for high blood pressure] are generally started when the blood pressure is above 140/90 mm/Hg, although they may be started at a lower blood pressure of 130/80 mm/Hg in people with [certain risk factors],” says Sarah McBane, Pharm.D., an associate dean of pharmacy education at the University of California, Irvine’s School of Pharmacy and Pharmaceutical Sciences.
Meanwhile, low blood pressure is marked by consistent systolic readings below 90 mm/Hg and diastolic readings below 60 mm/Hg. However, not everyone with low blood pressure requires treatment.
“Low blood pressure is a little more complicated,” says Dr. McBane. “Many people naturally have a blood pressure that is lower than normal. Medications are usually considered [only] when someone has symptoms from low blood pressure, such as severe dizziness.”
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Medications for High Blood Pressure
There are numerous classes of hypertension medications, and not all options are best suited for every person, so it’s important to work with a healthcare provider to find the right medication for your specific needs. In some cases, a healthcare provider may prescribe more than one medication.
Diuretics
Diuretics help lower blood pressure by reducing overall fluid in the body through urination. “These drugs are particularly beneficial in patients who also have heart failure, as they prevent fluid from collecting in the body,” says Victoria Hearn, Pharm.D., a cardiology clinical pharmacy specialist at the University of Maryland Baltimore Washington Medical Center. Diuretics are typically prescribed to be taken once or twice daily and may be used alone or in combination with other medications, she adds.
Diuretic use may lead to low electrolyte levels in the body. Potassium is one electrolyte that helps with muscle contractions, heartbeat regulation, and other crucial internal functions. As a result, patients taking diuretics may experience arrhythmias, muscle cramps, fatigue, or weakness.
ACE Inhibitors
Angiotensin-converting enzyme inhibitors, or ACE inhibitors, lower blood pressure by decreasing the amount of angiotensin, a hormone that causes blood vessels to narrow, produced by the body.
“These medications make it easier for the heart to pump and may slow the progression of kidney disease,” explains Dr. Hearn. “As a result, ACE inhibitors are good options for many patients, especially those who also have chronic kidney disease, heart disease, or diabetes.”
Some side effects of ACE inhibitors include a persistent dry cough, loss of taste, and skin rash. “Swelling of the lips, tongue, and throat leading to airway obstruction is a more serious, yet rare, side effect,” adds Dr. Hearn.
Angiotensin Receptor Blockers
Angiotensin receptor blockers (ARBs) reduce the effects of angiotensin in the body by blocking the receptor to which it attaches, helping relax the blood vessels and reducing blood pressure.
“ARBs are also preferred agents for patients who have chronic kidney disease, heart disease, or diabetes,” says Dr. Hearn. “And because they work similarly to ACE inhibitors, ARBs also reduce the workload of the heart and may slow the progression of kidney damage.”
Most ARBs are often prescribed to be taken once daily and may be a good option for those who experienced a dry cough or airway obstruction from ACE inhibitors, according to Dr. Hearn. However, she cautions that ARBs may cause high levels of potassium in the body and should be closely monitored when first started.
Calcium Channel Blockers
Calcium channel blockers (CCBs), also known as calcium channel antagonists, work by blocking the flow of calcium into the muscle cells of the heart and blood vessels. They help relax and widen the blood vessels, allowing for blood to flow more easily through the body and reducing overall blood pressure as a result.
According to Dr. Hearn, CCBs are effective, initial treatment options and are typically prescribed to be taken once or twice daily.
Side effects of CCBs may include constipation, low heart rate, edema, headaches, and feelings of lightheadedness.
Beta Blockers
Beta-blockers help lower blood pressure by reducing the effects of hormones, such as epinephrine (adrenaline) and norepinephrine, on beta receptors found throughout the body. Beta receptors are particularly concentrated in the heart and blood vessels, and blocking these receptors can slow heart rate and relax blood vessels, ultimately reducing blood pressure.
“Beta blockers are typically reserved for high blood pressure not adequately treated by first-line agents alone,” says Dr. Hearn. “However, they may be used as initial therapy in those with heart failure or other forms of heart disease, as they have proven to be beneficial in these populations.”
Beta-blockers may be prescribed alone or in combination with other medications when needed, and they’re usually prescribed to be taken once or twice daily, she adds.
Common side effects of beta blockers include insomnia, depression, tiredness, and slow heartbeat, a condition medically known as bradycardia.
Vasodilators
Vasodilators work by relaxing and widening the blood vessels, allowing blood to flow easier throughout the body and resulting in a decrease in blood pressure.
“Vasodilators are usually added for blood pressure not controlled by other medications alone and are prescribed to be taken once, twice, or three times daily,” says Dr. Hearn.
Some possible side effects of vasodilators include headaches, heart palpitations, and joint pain.
Alpha Blockers
Alpha-blockers work by blocking the action of hormones, such as epinephrine and norepinephrine, which can cause blood vessels to constrict. As a result, the blood vessels dilate and allow for more blood flow and reduced blood pressure.
“Alpha blockers are a good choice for high blood pressure treatment in patients who have a condition called benign prostatic hyperplasia (BPH), or an enlarged prostate,” explains Dr. Hearn. She adds that they are generally prescribed to be taken up to three times daily.
“Alpha blockers may cause a sudden drop in blood pressure when going from a seated to standing position, leading to possible dizziness or fainting, so it’s important to stand up slowly when taking these medications,” she says.
Alpha-2 Receptor Agonists
“Alpha-2 receptor agonists work by stimulating alpha-2 receptors in the brain, resulting in a decrease in neurotransmitters norepinephrine and acetylcholine,” explains Dr. McBane. This [reduction] ultimately relaxes the blood vessels so blood can flow easier, resulting in a reduction in blood pressure, she says.
“Alpha-2 receptor agonists are usually add-on agents for high blood pressure; they’re used when the more common blood pressure medications aren’t bringing the blood pressure down enough,” she adds.
Possible side effects of these drugs include dizziness and drowsiness. Furthermore, Dr. McBane adds that although most alpha-2 receptor agonists must be taken several times a day, it’s crucial to not miss a dose, as it can cause sudden increases in blood pressure known as rebound hypertension.
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Blood Pressure Medications for Low Blood Pressure
“Medications aren’t usually the first treatment option for low blood pressure concerns,” explains Shoshana Ungerleider, M.D., a board-certified internal medicine physician at Crossover Health and host of the TED Health Podcast.
However, medication may be prescribed after someone is screened for underlying causes, and non-medication options, such as lifestyle changes, prove unsuccessful in managing the condition. Below are several types of medications occasionally prescribed for low blood pressure management, followed by those only typically given in the critical care setting.
Mineralocorticoids
“Mineralocorticoids regulate the sodium and fluid balance in the body and can help increase blood volume and raise blood pressure,” says Dr. Ungerleider. Although the increase in blood volume generally doesn’t last long, the use of mineralocorticoids can lead to long-term results through increased vascular resistance.
Possible side effects of mineralocorticoids used for the treatment of hypotension include headaches, low potassium levels, and supine hypertension, the elevation of blood pressure upon lying on one’s back facing upward. Mineralocorticoids should generally not be used in patients at risk for heart failure or renal impairment.
Alpha-1 Agonists
Alpha-1 agonists work to increase blood pressure by increasing vascular resistance. They’re usually prescribed to be taken two to three times per day.
Possible side effects include goosebumps, chills, and urinary retention, and the inability to empty one’s bladder. It’s recommended to avoid taking these medications within four hours of bedtime to avoid high blood pressure at night.
Acetylcholinesterase Inhibitors
Acetylcholinesterase inhibitors, more commonly known as cholinesterase inhibitors, prevent the breakdown of the neurotransmitter acetylcholine, which can ultimately lead to increased blood pressure—especially upon standing. These medications are particularly useful for people with a specific type of low blood pressure called orthostatic hypotension that’s caused by dysfunction of the nervous system.
Side effects may include abdominal cramps, diarrhea, increased production of saliva, and urinary incontinence. These medications are generally prescribed to be taken one to three times per day.
Prodrugs
Prodrugs are inactive drug derivatives that are then converted to the effective form within the body. Certain prodrugs may be used in the treatment of low blood pressure.
Side effects may include headache, dizziness, and nausea. It’s recommended to avoid taking these medications within three to five hours of bedtime to avoid high blood pressure at night.
Vasopressors
Vasopressors cause the blood vessels to constrict, which then raises blood pressure, explains Dr. Ungerleider. Some may also work to increase cardiac output, which further helps increase blood pressure and distribute blood throughout the body.
These drugs are commonly given intravenously to critical care patients with shock or extremely low blood pressure.
Side effects of vasopressors depend on the specific medication. However, possible side effects may include hypertension, arrhythmias, rapid heart rate, and peripheral vasoconstriction leading to local tissue necrosis.
Corticosteroids
“Certain corticosteroids, or steroids, can help increase blood volume and raise blood pressure by retaining sodium and fluid in the body,” says Dr. Ungerleider.
A health care provider may prescribe corticosteroids alone or in addition to a vasopressor and typically in a critical care setting. However, they can cause side effects, such as excessive fluid retention, supine hypertension, and low potassium levels.
Questions to Ask Your Doctor
Not all medications are well-suited for every patient. Before starting any new medication, it’s important to understand what you’re taking, how it works, and possible side effects, explains Dr. Ungerleider.
She advises that patients ask their doctors the following questions before starting any blood pressure medication:
- What does this medication do, and how does it work to control blood pressure?
- What are the potential side effects of the medication, and what should I do if I experience them?
- How often should I take the medication?
- Do I need to take the medication with food or at a specific time of day?
- What should I do if I miss a dose?
- Are there any potential food or drug interactions?
- How long do I need to take the medication?
- Will the medication interact with any other health conditions I have or medications I’m taking?
“It’s important for patients to have a clear understanding of their blood pressure medication and to follow their doctor’s instructions carefully,” advises Dr. Ungerleider. “If they have any questions or concerns, they shouldn’t hesitate to ask their doctor or pharmacist for more information.”
Blood Pressure Medications: Types, Benefits, Risks
