High Blood Pressure Drugs at a Glance

Note: Talk with your doctor first before making any changes in dosage or switching prescriptions.

Thiazide diuretics & thiazide diuretics in combination with ACE inhibitors & angiotensin II receptor blockers; loop diuretics; potassium-sparing diuretics

Advantages: Thiazide diuretics and thiazide diuretics in combination with ACE inhibitors and angiotensin II receptor blockers have been proven effective and safe for lowering blood pressure; they are also relatively inexpensive. Therefore, they are often the first drug of choice for treating hypertension. Loop diuretics are sometimes recommended for people with congestive heart failure or other conditions that cause the body to retain fluid.

Disadvantages: Diuretics can cause frequent urination, fatigue, dizziness on standing, impotence, increased sensitivity to sunlight, gout, dehydration, and small increases in blood sugar and cholesterol. High doses of thiazide diuretics (50 to 100 mg per day) may increase the risk for heart attacks. Thiazide and loop diuretics can cause the body to lose too much potassium. Potassium-sparing diuretics raise potassium levels, which can be dangerous for people with kidney disease. Caution should be taken when using potassium-sparing diuretics with ACE inhibitors, which also raise potassium levels.

Beta blockers

Advantages: Along with diuretics, these drugs are frequently chosen as the first line of treatment for high blood pressure. They have characteristics that also make them helpful for people with angina or an arrhythmia or who have had a prior heart attack.

Disadvantages: Fatigue is the most common side effect of these drugs, so active people may want to avoid them. They may be used in special situations in people with congestive heart failure, but should not be used in patients with severe asthma. People with diabetes should be cautious about using these drugs, which can mask drops in bloodsugar levels.

ACE inhibitors

Advantages: These drugs cause few side effects. They are good for active people because they don’t produce fatigue. The drugs also may slow kidney damage in people with diabetes. Unlike diuretics and beta blockers, ACE inhibitors don’t raise blood cholesterol, which makes them a good choice for people with high cholesterol. Ramipril has been shown to lower the risk for heart attack, stroke and diabetes.

Disadvantages: Many people using these drugs develop a dry cough. A few develop a skin rash, swelling in the mouth or a lessening of their ability to taste. People with severe kidney disease must use these drugs with caution. Pregnant women should avoid these drugs as should other women of child-bearing years, unless they are using effective contraception.

Note: Talk with your doctor first before making any changes in dosage or switching prescriptions.

Angiotensin II receptor blockers

Advantages: These drugs have few side effects. They work similarly to ACE inhibitors, but don’t produce a cough and are usually taken only once a day. Lorsartan has been shown to improve high blood pressure-related male impotence.

Disadvantages: Although uncommon, side effects can include dizziness and fatigue. Pregnant and breastfeeding women should avoid these drugs. So should women in their child-bearing years, unless they are using effective contraception.

Calcium channel blockers (long-acting)

Advantages: Side effects of these drugs tend to be mild. Because they do not produce fatigue, they are sometimes recommended for active people. These drugs have proven especially effective in older people.

Disadvantages: Possible side effects include constipation, a rapid heartbeat, dizziness, nausea, and swelling, especially of the feet, lower legs and gums. These drugs should be used cautiously by people with heart arrhythmia or liver disease. Recent studies suggest that these drugs may increase the risk for heart attack. Other studies suggest these drugs may make men temporarily infertile.

Alpha blockers

Advantages: These drugs are helpful for people with high cholesterol because they lower triglycerides and LDL cholesterol. They can also help reduce the symptoms of benign prostatic hyperplasia (BPH) in older men.

Disadvantages: People sometimes become dizzy or even faint after taking these drugs, especially after the first dose. The effectiveness of the drugs can diminish over time.

Central alpha agonists

Advantages: These drugs can also help ease symptoms associated with migraine headaches, panic attacks, and drug or alcohol withdrawal. Methyldopa is considered safe for use by pregnant women. Catapres is available as a skin patch that is reapplied only once a week.

Disadvantages: Severe dizziness and/or drowsiness may occur. Other possible side effects include nausea, rapid heartbeat, headache, dry mouth, constipation, fatigue, sleep problems, depression, anxiety and impotence.

Blood vessel dilators

Advantages: These potent drugs can be very effective in cases of severe hyper-tension. Side effects can be minimised by combining these drugs with a beta blocker and a diuretic. Minoxidil is helpful when severe hypertension is accompanied by kidney problems.

Disadvantages: These drugs can speed up the heart and cause the body to retain water, which is why they are usually prescribed with other anti-hypertensives. Other possible side effects include dizziness, headache, loss of appetite, gastrointestinal problems, eye tearing, stuffy nose, skin rash and breast tenderness. Minoxidil may cause body hair to grow thicker or darker. High doses of hydralazine may increase the risk for developing lupus.