Other medications sometimes used to treat high blood pressure

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 relax certain muscles and help small blood vessels remain open. They work by keeping 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.

    Frequently 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 for people with high blood pressure who are at risk of heart failure. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
  • Central-acting agents. These 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 blood vessels.

    Clonidine (Catapres, Kapvay), guanfacine (Intuniv, Tenex) and methyldopa are examples of central-acting agents.

  • Vasodilators. These medications open (dilate) blood vessels. They affect the muscles in blood vessel walls, preventing the muscles from tightening and the walls from narrowing. As a result, blood flows more easily through your vessels and your heart doesn't have to pump as hard.

    Other blood pressure medications, such as calcium channel blockers, also dilate blood vessels. But the vasodilators that work directly on the vessel walls are hydralazine and minoxidil.

  • Aldosterone antagonists. These are often used with other drugs, such as a diuretic, for black people, older people, people with heart failure, people with diabetes and people whose hypertension is difficult to treat. Examples are spironolactone (Aldactone) and eplerenone (Inspra).

Each of the blood pressure drugs has been shown to lower blood pressure. However, different people respond better to certain drugs than other people do, which often depends on age, sex, race, how high your blood pressure is and your other health conditions.

A two-drug combination generally is more effective than is a single drug to get your blood pressure under control. Sometimes a third medication, or more, is needed to achieve your blood pressure goal.

High blood pressure and other health problems

High blood pressure often goes hand in hand with other health problems, including:

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

High blood pressure itself puts you at higher risk of having one of these conditions. If you already have one or more of these conditions plus high blood pressure, your chance of developing complications increases. A targeted treatment approach might reduce your risk of these complications.

For example, if you have chest pain (angina), your doctor may recommend a beta blocker, which can lower your blood pressure and also prevent your 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.

Keep trying to reach your blood pressure goal

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. Regular, accurate recordings can help your doctor monitor your treatment program. However, home blood pressure monitoring isn't a substitute for visits to your doctor, and home blood pressure monitors have some limitations.

In most cases, a combination of lifestyle changes and medication can help you successfully control your blood pressure. Finding the right combination of treatments to keep your blood pressure under control is likely to take time and effort, but it can mean a longer life, with fewer health problems.

July 06, 2016 See more In-depth