Hypertension Treatment Options

Types of drugs for high blood pressure

Last reviewed: 01 Mar 2019

Man with his arm strapped to a monitor that shows high blood pressure is in need of treatment for hypertension

Key takeaways

  • There are two ways to reduce blood pressure: lifestyle changes and medications

  • There are over 100 different medications prescribed to treat high blood pressure

  • It is important to speak to your doctor to find the best suited prescription medication for you

  • If you have been diagnosed with high blood pressure, you can start your online consultation now and obtain your repeat prescription from one of our GMC-registered doctors

Contents of this article

Different cases of high blood pressure call for different treatments. This can involve different drugs, different dosages and lifestyle changes.

If you have been diagnosed with a blood pressure above 160/100mmHg – read 160 over 100 – that means you’re in stage 2 hypertension and must be treated without delay.

Likewise, people in stage 1 hypertension (blood pressure above 140/90mmHg) who also suffer from diabetes, chronic kidney disease or a cardiovascular disease must seek treatment to prevent a possible heart attack.

If you have been diagnosed with high blood pressure, you can start your online consultation now and obtain your repeat prescription from one of our GMC-registered doctors. This service is for patients who have been taking the same high blood pressure medication for at least three months.

How to treat hypertension - medications and lifestyle changes

There are two ways to reduce blood pressure:

  • Lifestyle changes: eat healthily (less salt/caffeine/alcohol), quit smoking, lose weight (if you are overweight) and exercise more regularly
  • Medications: control blood pressure and maintain it at a safe level, even though they do not cure the disease

Medical treatments for hypertension provide an effective protection against stroke, heart attack and other cardiovascular conditions. However, to effectively treat your hypertension, you will also need to implement substantial lifestyle changes and improve your overall health.

Prescription Hypertension Medications

There are currently over 100 different drugs that are prescribed to treat high blood pressure. Some medicines work better in certain people, and other medicines create less side-effects in other people. Which medication is best for you depends on a variety of factors such as your age, your ethnicity (Afro-Caribbeans and South Asians seem more at risk), pre-existing conditions and any other ongoing treatment.

That’s why a visit to your doctor is essential, not only to properly diagnose high blood pressure, but also to increase your chances of quickly finding the right medication. It’s not uncommon for patients to try one or two different drugs before finding the right one.

Many people also need a combination of two or more different treatments for hypertension in order to reach their target blood pressure level. However, even if you don’t reach your target level right away, do not worry. Any reduction in blood pressure will be beneficial to your body.

The following medications are prescribed to treat hypertension and are sometimes used in combination:

  • Alpha-blockers
  • Beta-blockers
  • ACE inhibitors (ACE stands for angiotensin-converting enzyme)
  • ARBs – angiotensin II receptor blockers
  • Calcium channel blockers
  • Diuretics
  • Renin inhibitors
  • Vasodilators

Just keep in mind that there is not really a single best treatment for hypertension. Any treatment may work well for you, depending on how your body responds to the medication and on whether you have a condition that is incompatible with a certain drug.

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Alpha blockers work by blocking alpha receptors on muscles around blood vessels (e.g. arteries). By contracting, these muscles can narrow your arteries; alpha blockers serve to relax the muscles and prevent the narrowing of arteries that causes high blood pressure.


Beta Blockers cause the heart to pump blood at a slower pace and beat less hard, which results in a reduced blood pressure in the body. They are often prescribed for angina but are not recommended for people who suffer from asthma, certain lung diseases as well as certain cardiovascular conditions.

Beta-blockers are not always effective for everyone but can work very well in combination with other drugs for high blood pressure such as diuretics or alpha-blockers.

Finally, you should avoid alcohol during your treatment with beta blockers since combining the two can dangerously increase the blood pressure lowering effect of your medication.

Alpha-beta blockers

Alpha-beta blockers combine the effects of alpha- and beta-blockers, meaning that they make your heart beat at a slower pace, while also dilating your blood vessels (as a result of alpha receptors being partly blocked).

ACE Inhibitors (angiotensin-converting enzyme)

ACE inhibitors work by limiting the activity of a molecule (enzyme) in your body that causes your arteries to narrow. They are very common medications for moderate to high blood pressure as well as diabetes-related conditions.

Unlike beta-blockers, ACE inhibitors are generally recommended for people with diabetes and they’re also helpful to those with heart issues. However, if you have some form of kidney or blood vessel condition you should not take ACE inhibitors. The use of these treatments for hypertension requires regular monitoring of your kidneys. ACE inhibitors depend on the health of your kidneys to work effectively.

For greater effectiveness, ACE inhibitors are often combined with diuretics (e.g. lisinopril hctz – hydrochlorothiazide) or with beta-blockers.

Angiotensin II Receptor Blockers (ARBs)

Angiotensin II Receptor Blockers act on the same mechanism as ACE inhibitors do. The only difference is that they restrain the activity of a different molecule.

As a result blood vessels tend to expand, which lowers your blood pressure.

Medications such as Losartan and Valsartan (Diovan®) are the most common forms of Angiotensin II Receptor Blockers.

Calcium Channel Blockers (CCBs)

Calcium Channel Blockers are sometimes recommended when other treatments have failed.

Calcium is something that your muscles need to contract, and that includes those around your arteries and in your heart. By controlling the absorption of calcium into the muscles, this medication causes your arteries to relax and your heart to pump with less strength. The overall result is therefore a lower blood pressure.

There are however three different types of calcium channel blockers; mostly dihydropyridine which does not affect the heart and two types of non-dihydropyridine (phenylalkylamine and benzothiazepine) which do affect the heart.

The most common calcium channel blockers are verapamil (phenylalkylamine) and diltiazem (benzothiazepine) as well as amlodipine – probably the most common of all dihydropyridines.

Avoid drinking any grapefruit juice when taking Calcium Channel Blockers because it dangerously increases the concentration of medication in your blood (and the risk of serious side effects).

Diuretics (also known as water pills)

Diuretics are one of the oldest treatments for hypertension. Today, water pills are commonly used to complement other treatments for hypertension when a single drug isn’t effective enough. They are often combined with ACE inhibitors or calcium channel blockers.

Diuretics work by helping your body to get rid of more water and salt when you urinate. This helps to lower your blood pressure by reducing the amount of blood which circulates your body.

Taking diuretics for hypertension requires the same monitoring of your kidneys in the same way as for ACE inhibitors, to make sure that they function properly and that no condition is affecting the treatment.

Thiazides are the most commonly prescribed type of diuretics in the UK. You can recognize it in the compound drug Lisinopril HCT, where “HCT” stands for “hydrochlorothiazide” (“hydro” referring to water, and “thiazide” to the type of drug).

Diuretics are also recommended for people who have too much salt in their body.

There are also other types of diuretics (i.e. potassium-sparing and loop diuretics), which are used in people who mustn't lose too much potassium, or who suffer from kidney disease.

Renin Inhibitors

Renin inhibitors control a mechanism of the kidneys that serves to increase blood pressure.

This medication for high blood pressure is not to be taken with ACE inhibitors or Angiotensin Receptor Blockers because of potentially dangerous drug interactions.


Vasodilators work directly on the muscles surrounding your blood vessels by preventing them from contracting and thus narrowing your arteries. This way your blood vessels remain relaxed and your blood can flow through your arteries more easily.

You may also be advised to take a small amount of aspirin every day to help regulate your heartbeat and blood circulation.

Combination Treatments for Hypertension

For about 50% of patients, taking only one medication for hypertension is enough to reduce their blood pressure to the target level. This means that the other 50% are only able to reach their target level by using two or more drugs for high blood pressure.

In about 30% of cases, at least three medicines are needed to substantially reduce blood pressure. Yet, even if you don’t reach your target level immediately, keep in mind that any reduction in your blood pressure means an improvement.

The common guideline concerning the prescription of treatments for hypertension is the following: A or C, then A+C, then A+C+D

  • Less than 55 years old, no ethnic risk factor, then treat with “A” – for ACE inhibitor (or ARB if the ACE inhibitor poses problem, generally the cough)
  • Over 55 years old or ethnic risk factor (Afro-Caribbean or South Asian), then treat with “C” – for calcium channel blocker;
  • If single medication isn’t enough, combine “A + C” – ACE inhibitor with calcium channel blocker
  • If a double combination treatment isn’t enough, combine “A + C + D” – ACE inhibitor with Calcium Channel Blocker and diuretics (water pills)

If you need to take an additional drug then the doctor will review which of Alpha-blocker, Beta-blocker or an additional water pill is best for you.

Sometimes, however, when one particular medication doesn’t work, your doctor may find that your body responds much better to another one and that there is no need for a combined treatment.

The reason why it’s better to combine different drugs rather than giving you one single medicine is that combinations of low doses work better than one high dose of one medicine.

Side Effects of Treatments for Hypertension

As you’ve seen, there are many factors that help your doctor decide between different treatments for hypertension. Your age, current treatments and pre-existing conditions can all have an impact on the medication you’re taking and its side effects.

Common side effects of treatments for hypertension are:

  • ACE Inhibitors can cause a persistent cough (1 in 10 patients), which is the main reason why people wish to change treatment
  • Angiotensin II Receptor Blockers can to cause light-headedness
  • Beta-blockers sometimes cause fatigue, depression, insomnia and impotence
  • Calcium Channel Blockers also cause dizziness because of hypotension, along with possible heart failure and some mild discomforts such as flushing and constipation
  • Diuretics increase the risk of gout attacks (inflammatory arthritis – usually joints and tendons), although not at low dose. They also increase blood sugar and cholesterol. There is a risk of occasional impotence too
  • Vasodilators can cause headaches, drowsiness and palpitations

If the side-effects of these treatments for hypertension sound rather daunting, you must remember that these medications help treat very severe conditions such as cardiovascular disease as well as kidney problems.

Last reviewed: 01 Mar 2019

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