Medications for high blood pressure

If you have high blood pressure, you might need to take medications to help lower it.

Making healthy changes to your lifestyle could be enough to lower your blood pressure to a healthy level, but some people will also need medicines.

If you start taking high blood pressure medicines, it’s likely you will need to keep taking them for a long time. If your blood pressure stays under control for several years, you might be able to take a lower dose or stop taking them altogether. Making healthy changes to your lifestyle can help.

• Are blood pressure medications right for you?
  High blood pressure doesn’t usually have any symptoms and you might feel absolutely fine, which can make the idea of taking medicines hard to accept. But if it’s not brought under control, high blood pressure can lead to heart attacks, strokes, and a number of other serious health problems. This is why your doctor might want to discuss medications with you as well as changes to your lifestyle. Read more. 

• Types of blood pressure medicines
  There are lots of different medications which can be used to treat high blood pressure. If one type doesn’t work or gives you side effects, you should be able to try a different dose or a different medication. Read more. 

• Finding the right blood pressure medications for you
  Everyone is different, and some blood pressure medications might work better for you than others. It’s also quite common to take more than one type of blood pressure medication at the same time because they work in different ways. Some people will take three of four, and sometimes five or more.
  
  It can take a bit of trial and error to find which medication or combination of medications will work well for you.  

• Side effects of blood pressure medications
  All medications can have side effects, including blood pressure medications, but it’s likely you won’t have any side effects at all. You might have some side effects which don’t cause you too many problems, but sometimes they can affect your day to day life. Read more. 

• Getting the most from your medicines
  If you start taking blood pressure medications, it’s likely that you will need to take them for the long term. If you stop taking them, your blood pressure will quickly rise again. Your blood pressure medicines will keep your blood pressure under control and stop you developing serious health problems.
  
  Taking your medications every day at the same time, keeping in touch with your doctor and looking after your health in other ways will all help your medications to work well. Learn more about getting the most from your medicines. 

• Working with your doctor or nurse
  Ultimately, it’s up to you to decide on a plan with your health professional that works for you. Ask your doctor or nurse as many questions as you need to. They can help you understand why the medications could help, any pros and cons, and what to do if you experience any problems with the medications.
  
  If you have a partner or carer, you can take them along to your appointments with your doctor to help you make a decision.
  
  Your doctor or nurse will want to see you again fairly soon after you start a new medicine. This is to see how well it’s working for you and if you have any side effects. They may be able to change the dose and there are often other medications you can try if you need to. 
  
  Read the stories of people who are living well with blood pressure medications.  

• If your blood pressure isn’t brought under control by medications
  
  Occasionally medications don’t bring blood pressure down low enough, even if you’re having more than one type of medication and at the highest possible dose. This is called resistant hypertension. Sometimes the medications bring blood pressure down but the side effects are too much to live with.
  
  If you have resistant hypertension or severe side effects, you can ask to be referred to a specialist for help.

Are blood pressure medications right for you?

When you’re first diagnosed with high blood pressure you might not need to take medications. Your doctor or nurse might suggest you make healthy changes to your lifestyle first, which could be enough to lower your blood pressure to a healthy level, but if that’s not enough on its own, they may suggest you take medications as well.

The role of blood pressure medicines is to lower your risk of heart disease, stroke, and other health problems. So, whether you would benefit from them depends not only on your blood pressure, but on your overall health and risk of disease. Your doctor will consider a number of things, including:

• what your blood pressure numbers are
• your age, ethnicity, family history and lifestyle
• any other health problems which raise your risk of heart attack or stroke, such as high cholesterol, being overweight, diabetes, kidney problems and diseases of the blood vessels such as coronary heart disease
• if members of your family have high blood pressure, strokes or heart attacks, or have done in the past
• any other illnesses you may have and medications you’re taking, and any side effects

How high does your blood pressure need to be before starting medications?
Your doctor will consider your blood pressure numbers when deciding whether to prescribe medications.

• If your blood pressure is 140/90mmHg or over this is considered high. If you are otherwise in good health, and your overall risk of heart attacks and stroke is low, changes to your lifestyle might be enough. If your risk of serious health problems is higher, for example if you are overweight or have diabetes, then your doctor might suggest you start taking medications as well as improving your lifestyle.
• If your blood pressure is over 160/100mmHg your risk of serious problems is higher and your doctor will offer you medications as well as talking to you about changes to your lifestyle.

Your doctor will want to bring your blood pressure down to a target level, for example around 140/90mmHg.

Making a decision
Blood pressure medications can sometimes cause side effects, which can be difficult to face if you feel fine or if you already have side effects from other medications. Whether you start taking medications is up to you. Speak to your doctor or nurse and make sure you have as much information as you need before making a decision.

Types of blood pressure medicines

There are four main types of medicine to lower blood pressure.

• ACE inhibitors. ACE (Angiotensin-converting enzyme) inhibitors help to control hormones that play a role in blood pressure control. They help the blood vessels to relax and widen, lowering blood pressure. Most have names that end in ‘pril’, for example, enalapril, lisinopril, perindopril and Ramipril.
• Angiotensin receptor blockers (ARBs). These work in a similar way to ACE inhibitors, controlling the hormones that affect blood pressure, so you probably won’t take ACE inhibitors and ARBs at the same time. They’re usually used if ACE inhibitors are causing side effects. Most have names that end in ‘artan’, for example, candesartan, irbesartan, losartan, valsartan and olmesartan.
• Calcium-channel blockers (CCBs). These allow the artery walls to relax, making them wider. This allows more blood to pass through, lowering blood pressure. Most have names that end in ‘pine’ (pronounced, peen), for example, amlodipine, felodipine and nifedipine. 
• Thiazide diuretics. These are sometimes known as water pills because they remove excess fluid from the body, including from the blood. This means there is less pressure on the blood vessel walls. Most have names that end in ‘ide’, for example, indapamide and bendroflumethiazide.

Sometimes these medications won’t be suitable, for example if you’re pregnant or breastfeeding, if you have certain other health problems, or you’re taking other medications which could react with them.

Alternatively, you might need to take another type of medication as well to lower your blood pressure enough.

The other medications available include:

• beta blockers
• alpha blockers
• centrally acting antihypertensive drugs (central alpha antagonists)
• vasodilators
• renin inhibitors - aliskerin

    Download our Non-standard medicines information sheet [PDF 23,510KB].

Learn about each of the medicines for high blood pressure 

ACE Inhibitors * Renin inhibitors – aliskiren * Alpha-blockers * Angiotensin receptor blockers (ARBs) * Beta-blockers
Calcium-channel blockers (CCBs) * Centrally acting antihypertensive drugs (central alpha antagonists)
* Vasodilators * Diuretics

Finding the right blood pressure medications for you 

How blood pressure medicines work

Your body is constantly working to keep your blood pressure under control. There are receptors in your blood vessel walls which detect when your blood pressure is too high or low. In response, your nerves, hormones and kidneys all play a role in bringing it back to a safe level.

Over time, your blood pressure can creep up for a number of reasons, including an unhealthy lifestyle, and medications can help to bring it back down. They do this by acting on the ways your body controls blood pressure. Some affect the nerves or hormones which send signals to your blood vessel walls, telling them to relax or contract, while some affect the kidneys, causing them to remove excess salt and water from the blood.

Taking more than one medicine

Taking a combination of different medicines can work better than taking one, because they work in different ways. Taking a low dose of two medications rather than a high dose of one, can also help to avoid side effects, as side effects can sometimes be caused by the dose.

Sometimes a medication will work well to begin with, but with time your blood pressure might creep up again. You may then need to take another medicine alongside it which works in a different way. 

Choosing a medicine to suit you

Which medications will be suitable for you depends on a number of things, including your:

• age
• ethnic background
• any other health problems you may have, such as kidney disease or angina
• any other medications you’re taking
• any blood pressure medicines you have tried in the past
• your preferences.

There are steps your doctor or nurse can work through to find the right medications – have a look at the table below. If one step doesn’t work, they will review your treatments to see if the right doses are being used, then move onto the next step.

You will probably start with a low dose of a medication, and your doctor will gradually raise it, so they can keep an eye on how your blood pressure is responding while keeping side effects to a minimum. 

Finding the right combination of medicines

   Dowload our Combined blood pressure medicines information sheet [PDF 10,622KB].

Simplifying your medicines

If you need to take more than one medicine and it’s difficult to manage, speak to your doctor about simplifying the dose.

It’s sometimes possible to have two medicines in a single tablet, sometimes called a combination tablet. These can mean you can take fewer tablets. They are available for some combinations of blood pressure medicines but not all, your doctor, nurse or pharmacist will be able to advise you on whether there’s one that’s suitable for you.

You can also use compartment boxes to get your medicines ready for the week. Getting the most from your medicines. 

Side effects of blood pressure medications

Occasionally, side effects only happen when you first start taking a new medication or a higher dose. As your body gets used to the medicines the side effects improve or go away.

If you have side effects which don’t go away
Sometimes side effects don’t go away and can affect your day to day life. If this happens, it’s important that you don’t simply stop taking them because your blood pressure will go back up.

Instead, talk to your doctor because they will be able to try a lower dose of your medication, a different medication, or a different combination of medications. Often this will lower your blood pressure with no problems at all.

If you have tried different options and you’re still experiencing side effects, your GP can refer you to a blood pressure specialist. They can often help you get the right balance between controlling your blood pressure and keeping the side effects to a minimum, and might be able to try different treatments.

What are the possible side effects?
The side effects vary with the different medications. They also vary from person to person. For example, ACE inhibitors can cause a dry cough in some people, but dizziness or an upset stomach in others. The leaflet that comes with your medication will include a list of possible side effects.

A common side effect is feeling faint or dizzy when you go from sitting or lying down to standing up, especially at night. This is called postural hypotension, and can happen with any blood pressure medication.

If you notice anything unusual when you start taking a new medication or a higher dose, speak to your doctor, nurse or pharmacist. 

Make sure your doctor or nurse knows about all the medicines you are taking, including herbal medicines and over-the-counter treatments like cold remedies.

Reporting new side-effects
If you experience any problems which are not on the leaflet which comes with your medicines, you can report them via the Yellow Card Scheme. This helps to identify any side effects which weren’t known before. You can also speak to your doctor, nurse or pharmacist.

  Download our Side-effects of blood pressure medicines information sheet [PDF 11,198KB].

Getting the most from your blood pressure medicines

The following tips should help you to get the most from your medicines.

• Take your medications as prescribed. This helps them work properly. Your doctor will let you know how many tablets to take each day as well as anything else you need to know. For example, if there is a particular time of day to take them, if you can take them with food, and if you can take all your medicines together. Any important information will also be printed on the packet to remind you.
• Take your medications at the same time every day. Getting into the habit of taking all your blood pressure medicines at the same time every day will help you remember to take them. You could make them part of your routine – your blood pressure will usually be highest early in the morning, so you could take them with breakfast.
• Use a pill box. Sorting your tablets into a pill box, also called a pill organiser, can help you remember to take your tablets. These are simple containers with a separate compartment for each day of the week – so you can see at a glance if you have taken your tablets for the day. You can buy pill boxes for less than £5 from online retailers or from your local pharmacy.
• If you miss a dose, don’t take two tablets together. It’s important not to take too much in one go as your blood pressure could drop too low. If you forget to take a tablet, take it as soon as you remember unless your next dose is due, in which case just take one then carry on as normal.
• Find out more about your medicines. Read the information that comes with your blood pressure medicines. This will help you recognise any side effects and see if there’s anything else you need to know, for example if there’s any medicines or herbal remedies you shouldn’t take at the same time. If you have any questions, ask your doctor, nurse or pharmacist.
• Remind yourself why you’re taking your medicines. Some people don’t like the idea of taking medications, especially if they feel fine. Try to remember the reason you’re taking them, and that they’re reducing the risk of you having a heart attack or stroke.
• Speak to your doctor if you’re struggling. It’s important that you don’t simply stop taking your medications because your blood pressure will quickly rise again. Always let your doctor know if you’re struggling because there could be other options you can try. For example, you could try other medications or you could see a specialist.

          Getting your medicines and doses right takes time and patience for both you and your doctor. 

• Think about measuring your blood pressure at home. If you measure your blood pressure at home and keep a record, you will be able to monitor how well your medicines are working. You can also record any side effects to see if they’re improving with time. This can help you feel more in control.
• Make healthy changes to your lifestyle. Lowering your blood pressure with a healthy lifestyle will mean you can rely less on medicines. It might be possible to lower the dose or stop taking some or even all of your medicines. A healthy lifestyle can also help your medicines to work better. 
• Speak to your pharmacist before buying or taking other medicines. Different medicines can react with each other in your body. If you’re taking high blood pressure medicines, speak to your pharmacist before taking other medications to check that they’re safe. This includes over the counter medicines, for example, anti-inflammatories, pain killers and herbal remedies.
• Ask your Pharmacist for a Medicines Use Review (MUR).If you’re taking a number of different medicines, it may be useful to ask your pharmacist for a Medicines Use Review (MUR). This is a chance for you to talk to your pharmacist about how you’re getting on with your medicines, including any problems you’re having, so they can help you get the most benefit from them.
• Store your medicines in a cool, dry place, away from direct heat and light.

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