Choosing blood pressure medications

There are many different high blood pressure medications (antihypertensives) available, each with pros and cons. Your doctor might prescribe more than one type to treat your condition.

If you have high blood pressure or are at risk of developing it, lifestyle changes can help keep your numbers under control. But you might need medication too.

Taking your medications as prescribed, monitoring your blood pressure and making lifestyle changes can help you reach and maintain a healthy blood pressure.

If you're beginning to develop high blood pressure (prehypertension) or if you already have it, lifestyle changes can help you reduce or eliminate your need for medication.

Try these lifestyle changes to help lower and control your blood pressure.

• Eat a healthy diet with plenty of fruits and vegetables and reduce the amount of sodium in your diet.
• Maintain a healthy weight.
• Exercise. Get 30 minutes of moderate activity on most days of the week. It's OK to break up your activity into three 10-minute sessions a day.
• Limit the amount of alcohol you drink. For healthy adults, that means up to one drink a day for women of all ages and men older than 65, and up to two drinks a day for men 65 and younger.
• Don't smoke.
• Manage stress.

If making lifestyle changes isn't enough to control your blood pressure, your doctor will likely prescribe blood pressure medication. You may be given one or more of these medications:

• Diuretics, also called water pills. A diuretic removes excess water and sodium from your body, so there's less fluid flowing through your veins and arteries. This reduces pressure on the walls of your blood vessels.

  There are three types of diuretics: thiazide, loop and potassium-sparing. Examples of diuretics include chlorothiazide (Diuril), bumetanide (Bumex) and amiloride (Midamor).

  If diuretics aren't enough to lower your blood pressure, your doctor might recommend adding other blood pressure medications to your treatment.

• Angiotensin-converting enzyme (ACE) inhibitors. These help relax blood vessels by preventing the formation of angiotensin, a chemical in your body that narrows blood vessels.

  There are several ACE inhibitors available. Examples include enalapril (Vasotec, Epaned), lisinopril (Prinivil, Zestril, Qbrelis) and ramipril (Altace).

• Angiotensin II receptor blockers (ARBs). These drugs block the action of angiotensin, a chemical in your body that narrows your arteries and veins. ARBs include valsartan (Diovan), losartan (Cozaar) and others.

• Calcium channel blockers. These medications prevent calcium from entering the cells of your heart and arteries, allowing your arteries to relax and open.

  Examples of calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others), nifedipine (Adalat CC, Procardia) and verapamil (Verelan, Calan).

• Beta blockers. These drugs work by blocking the effects of the hormone epinephrine, also known as adrenaline. They cause your heart to beat slower and with less force. Examples of beta blockers include metoprolol (Lopressor, Toprol-XL), nadolol (Corgard) and atenolol (Tenormin).
• Renin inhibitors. Renin is a substance produced by your kidneys that triggers a series of steps that increases blood pressure. Aliskiren (Tekturna) slows the production of renin, which reduces its ability to begin this process.

If you're unable to reach your blood pressure goal with one or more of the above medications, other drugs that lower blood pressure include:

• Alpha blockers. Alpha blockers prevent the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller arteries and veins, which causes the vessels to remain open and relaxed. Commonly prescribed alpha blockers include doxazosin (Cardura), prazosin (Minipress) and terazosin.
• Alpha-beta blockers. Alpha-beta blockers work similarly to beta blockers. They might be prescribed if you have high blood pressure and are at risk of heart failure. Alpha-beta blockers include carvedilol (Coreg) and labetalol.

• Central-acting agents. These medications prevent your brain from sending signals to your nervous system to speed up your heart rate and narrow your blood vessels. As a result, your heart doesn't pump as hard and your blood flows more easily through your veins and arteries.

  Examples of central-acting agents include clonidine (Catapres, Kapvay), guanfacine (Intuniv) and methyldopa.

• Vasodilators. These medications prevent the muscles in your veins and arteries from tightening and narrowing. As a result, blood flows more easily and your heart doesn't have to pump as hard. Examples include hydralazine and minoxidil.
• Aldosterone antagonists. These medications are often used with other drugs, such as a diuretic. Aldosterone antagonists block the hormone aldosterone, which sometimes causes salt and fluid retention, contributing to high blood pressure. They are usually prescribed for those whose high blood pressure is difficult to control or who have diabetes or heart failure. Examples are spironolactone (Aldactone, Carospir) and eplerenone (Inspra).

How well a drug works for you can depend on your age, sex, race, blood pressure level and overall health.

Combining two drugs usually works better than a single drug to get your blood pressure under control. Sometimes additional medication is needed to achieve your blood pressure goal.

High blood pressure often goes hand in hand with other health problems. High blood pressure increases your risk of having one of these conditions:

• Chronic kidney disease
• Coronary artery disease
• Diabetes
• Heart attack or stroke
• Heart failure
• Swelling or thickening of the left chamber of the heart (left ventricular hypertrophy)

However, a targeted treatment approach might reduce your risk of these complications.

For example, if you have chest pain (angina) related to coronary artery disease, your doctor may recommend a beta blocker to lower blood pressure, prevent chest pain, reduce your heart rate and decrease your risk of death.

If you have diabetes and high blood pressure, taking a diuretic plus an ACE inhibitor can decrease your risk of a heart attack and stroke.

If you have diabetes, high blood pressure and kidney disease, you may need an ACE inhibitor or an angiotensin II receptor blocker.

In most cases, a combination of lifestyle changes and medication can help you successfully control your blood pressure. However, it's not unusual to try several medications or doses before finding what works best for you.

An important way for you and your doctor to know if your treatment is working is to monitor your blood pressure at home. Home blood pressure monitors are widely available and inexpensive, and you don't need a prescription to buy one. Remember that home blood pressure monitoring isn't a substitute for visits to your doctor.