In Depth


Although lifestyle modifications are the ideal way to treat high blood pressure, they may not be enough. You might need to take medications too. However, even if you are prescribed medications, following lifestyle changes also may help your medication work better and may reduce how much of it you need.

Understanding the role of medications can help guide your overall treatment strategy. That means you are more likely to get your blood pressure under control and see an improvement in your health.

There are many drugs available to lower high blood pressure called antihypertensives. Antihypertensives are grouped into eight main classes according to how they control your blood pressure. They work in various ways. Often, two or more drugs work better than one.

Here is a rundown on the main types of drugs and how they work:

DIURETICS: (e.g. Furosemide, Hydrochlorothiazide, Indapamide and others) These are sometimes called water pills because they work in the kidney and ush excess water and sodium from the body through urine. This reduces the amount of fluid in the blood. When sodium is flushed out of the blood vessel walls, the vessels open wider and pressure goes down. There are different types of diuretics. They are often used with other high blood pressure drugs.

ETA-BLOCKERS: (e.g. Atenolol, Metoprolol, Propranolol, and others) These reduce nerve impulses to the heart and blood vessels. This makes the heart beat less often and with less force. Blood pressure then drops and the heart does not work as hard.

ANGIOTENSIN converting enzyme (ACE) inhibitors: (e.g. Benazepril, Enalapril, Lisinopril, and others) These prevent the formation of a hormone called angiotensin 2, which normally causes vessels to narrow. The blood vessels relax and pressure goes down.

ANGIOTENSIN 2 receptor blockers (ARB): (e.g. Candesartan, Irbesartan, Losartan and others) ARBs act in a manner similar to ACE inhibitors, but they block the action of the chemical instead of the formation of the chemical.

CALCIUM channel blockers (CCBs): (e.g. Amlodipine, Diltiazem, Nifedipine,Verapamil and others) These medications keep calcium from entering the muscle cells of the heart and blood vessels. Blood vessels relax and pressure goes down. Some slow your heart rate.

ALPHA blockers: (e.g. Doxazosin,Terazosin, and others) These reduce nerve impulses to blood vessels, which allows blood to pass more easily and with lower pressure. Alpha blockers are usually used with other medications to manage high blood pressure. They may help to modestly lower your blood cholesterol and triglyceride levels.

ALPHA-Beta Blockers: These work the same way as alpha blockers, but also slow the heart beat, as beta blockers do. As a result, less blood is pumped through the vessels with lower pressure.

CENTRAL- ACTING AGENTS (Central Adrenergic Inhibitors): (e.g. Clonidine, Guanabenz, Guanfacine, Methyldopa and others) Instead of working on your blood vessels, these medications work on your brain. They prevent your brain from telling your nervous system to increase your heart rate and narrow your blood vessels.

VASODILATORS: These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
It’s important that you take the medication as prescribed, including in the right amount.


When you start on a medication, work with your doctor to get the right drug and the dose level for you. If you have side effects, tell your doctor so the medication can be adjusted. If you’re worried about cost, tell your doctor or pharmacist. There may be a less expensive drug or a generic form that can be used instead.

It’s important that you take the medication as prescribed, including in the right amount.


Talk with your doctor about any problems with your medications including forgotten doses, or if you are having a problem with forgetting doses. Don’t stop taking a medication without your doctor’s guidance because you feel it’s not working or you don’t like the side effects. If your

blood pressure is difficult to control, your doctor may have you try many different medications before finding the most effective combination.

Don’t be satisfied until you and your doctor nd a treatment strategy that controls your blood pressure. If you’re taking three or more medications and your blood pressure still isn’t at your goal, it might be a good idea to talk to your doctor about consulting a specialist in hypertension.

If your high blood pressure has been controlled for a year or more, talk to your doctor about the possibility of decreasing the dosage or number of medications you take (sometimes called step-down therapy). You and your doctor can make sure this process occurs slowly and progressively to monitor any changes in your blood pressure.

The good news is that high blood pressure medications are generally long acting and you only need to take them once a day. Sometimes different medications are combined into one pill, making it more convenient. In most cases, medications prescribed by your doctor will help bring your blood pressure under control if adopting healthy lifestyle modification alone isn’t sufficient.

Maintaining lifestyle changes may improve the effectiveness of the medications you are taking....

If you have been prescribed blood pressure medications, you will need to remember that maintaining lifestyle changes may improve the effectiveness of the medications you are taking. It may also mean that you eventually will need fewer drugs or lower dosages.