What are the best treatments for hypertension (high blood pressure)?

If you have hypertension, which is high blood pressure, taking steps to lower your blood pressure can greatly improve your health and well-being while reducing your risk of complications, like heart attack and stroke.

High blood pressure is very common. In fact, nearly half of the adults in the United States (47%) have it — and only 1 in 4 are managing their condition effectively.

The American Heart Association (AHA) says that high blood pressure is when your reading is between 130/80 millimeters of mercury (mm Hg) and 140/90 mm Hg. Treatment focuses on lowering your blood pressure and keeping it within a healthy range.

Lifestyle factors

Hypertension can have many causes, including stress, a high salt diet, and not enough exercise. Making small changes to your daily routine can have a measurable impact on reducing your blood pressure.

Many people can lower their blood pressure by using lifestyle strategies, including:

• eating a balanced diet focused on vegetables and fruits
• reducing your intake of salt and trans fat
• increasing your physical activity and exercise
• reducing your alcohol consumption
• quitting smoking

You can learn more about lifestyle strategies to manage hypertension here.

Blood pressure medications

Not everyone needs to take medication to manage their blood pressure, but doctors will sometimes recommend medications, such as beta-blockers like atenolol or diuretics like furosemide. Some people take medications long term.

The type of medication a doctor prescribes will depend on various factors. For example, according to the United Kingdom’s National Health Service (NHS):

• people under 55 often take angiotensin converting enzyme (ACE) inhibitors or angiotensin-2 receptor blockers
• people ages 55 and over often take a calcium channel blocker

Hypertension drugs can cause side effects, such as headaches, dizziness, constipation, and diarrhea. However, most people don’t experience side effects.

It's important to take hypertension medications as directed by a doctor or healthcare professional, as they won’t work well if you miss doses. An estimated 10% to 80% of people with hypertension have trouble keeping up with their medication.

Having trouble following your treatment plan? Consider speaking with a doctor about factors that might help.

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ACE inhibitors

These drugs help your blood vessels relax and widen, which helps lower your blood pressure. Most people take ACE inhibitors orally (by mouth), though some take them as injections, typically during a hospital stay.

The Food and Drug Administration (FDA) highlights several types of ACE inhibitors, including:

• lisinopril (Zestril, Prinivil)
• benazepril (Lotensin)
• captopril (Capoten)
• enalapril (Vasotec)
• moexipril
• perindopril

Pregnant people should avoid taking ACE inhibitors to treat hypertension. You can talk with your doctor about the best way to manage hypertension during pregnancy.

Alpha-blockers

Alpha-blockers lower blood pressure by preventing the arteries from tightening. This relaxes the muscle tone of the vein walls, allowing blood to flow more easily. Alpha-blockers are usually oral medications.

According to the AHA, types of alpha-blockers include:

• doxazosin mesylate (Cardura)
• terazosin hydrochloride (Hytrin)
• prazosin hydrochloride (Minipress)

Beta-blockers

Beta-blockers lower blood pressure by reducing your heart rate. You can take beta-blockers orally or, if you are an inpatient, they may also give them via injections.

Common beta-blockers include:

• metoprolol tartrate (Lopressor)
• metoprolol succinate (Toprol-XL)
• acebutolol (Sectral)
• betaxolol (Kerlone)
• carteolol hydrochloride (Cartrol)
• atenolol (Tenormin)
• propranolol (Inderal)

Another option is carvedilol (Coreg). This is a combination alpha-beta-blocker that you may typically receive through IV as an inpatient. However, if you are at risk of heart failure, a doctor may prescribe this medication to take home.

Alpha-2 receptor agonists

These drugs lower your blood pressure by slowing activity in your sympathetic nervous system. Doctors most commonly prescribe these drugs for pregnant people with hypertension.

Alpha-2 receptor agonists are available in oral tablets as a generic drug called methyldopa. 

Angiotensin-2 receptor blockers

Angiotensin is a chemical that narrows your blood vessels. Angiotensin-2 receptor blockers are medications that help blood vessels to stay open, thereby lowering your blood pressure.

Angiotensin-2 receptor blockers are usually taken by mouth. They are not appropriate for use during pregnancy. You can talk with your doctor about alternatives to treat hypertension during pregnancy.

Angiotensin-2 receptor blockers include:

• losartan (Cozaar)
• candesartan (Atacand)
• valsartan (Diovan)
• telmisartan (Micardis)
• eprosartan mesylate (Teveten)

Calcium channel blockers

Calcium channel blockers decrease the amount of calcium that enters the heart and artery muscle cells. With less calcium, the heart’s contractions are less forceful, which helps lower your blood pressure. 

They are most commonly taken by mouth but can also be intravenous if you're in the hospital.

Calcium channel blockers include:

• amlodipine besylate (Norvasc, Lotrel)
• bepridil (Vasocor)
• felodipine (Plendil)
• nicardipine (Cardene SR)
• nisoldipine (Sular)

Diuretics

Diuretics lower blood pressure by helping the body dispose of excess sodium and water.

People often use diuretics, also known as water pills, with other medications, such as calcium channel blockers. According to the AHA, there are three types of diuretics:

• thiazide diuretics, including metolazone (Mykrox), hydrochlorothiazide (Microzide), and chlorthalidone (Hygroton)
• potassium-sparing diuretics, including spironolactone (Aldactone) and triamterene (Dyrenium)
• loop diuretics, including furosemide (Lasix) and bumetanide (Bumex)

Types of hypertension

Treatments can help with various types of hypertension, including pulmonary hypertension, which affects the arteries that carry blood to the lungs, and gestational hypertension, which is high blood pressure during pregnancy.

Doctors and healthcare professionals recognize hypertension in two phases:

• Hypertension stage 1: blood pressure reading between 130/80 mm Hg–139/89 mm Hg
• Hypertension stage 2: blood pressure reading between 140/90 mm Hg–179/119 mm Hg

The AHA considers readings above 179/119 mm Hg to be a hypertensive crisis. If this happens, seek immediate medical help.

Summary

With treatment, many people can lower and manage their blood pressure at home. A mix of lifestyle strategies and medication is often the best approach.

Medications that help you manage your blood pressure include:

• ACE inhibitors
• alpha-blockers
• beta-blockers
• alpha-2 receptor agonists
• angiotensin-2 receptor blockers
• calcium channel blockers
• diuretics

Some lifestyle tips include eating a balanced diet with vegetables and fruits, increasing physical activity, reducing alcohol use, and building good stress management skills, among others.

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