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Blood Pressure Measurements
Blood pressure is measured in millimeters of mercury (mm Hg). The higher number is the systolic blood pressure, the pressure in your arteries while your heart is pumping blood. The lower number is the diastolic blood pressure, the pressure when your heart is relaxing and refilling with blood between beats. For adults:
Blood Pressure Screening Guidelines
Current guidelines from the U.S. Preventive Services Task Force recommend that all adults, ages 18 and older, have their blood pressure measured.
The U.S. Preventive Services Task Force also recommends that all people with blood pressure readings of 135/80 mm Hg or higher be screened for type 2 diabetes. (The American Diabetes Association recommends diabetes screening for people with blood pressure greater than 140/90.)
Home Blood Pressure Monitoring
Most people with high blood pressure will benefit from monitoring their blood pressure at home on a regular basis. Home monitoring can help show if blood pressure medications are working or if they need to be adjusted.
Lifestyle Changes and High Blood Pressure
Lifestyle changes are important for preventing and treating high blood pressure. Healthy choices include:
The DASH diet is a plan proven to improve blood pressure.
Medications for High Blood Pressure
Drug treatment for high blood pressure is tailored to the individual. There are many different types of blood pressure medications. Although some people need only one drug to control blood pressure, recent guidelines from the American College of Cardiology and the American Heart Association recommend a combination of two or more medications for people with blood pressure above 140/90 mm Hg.
Blood pressure measurements can fluctuate throughout the day and in different environments. The decision to start or increase blood pressure medications should not be based on a single blood pressure reading. To obtain the most accurate estimate of your true blood pressure, your doctor will use an average of multiple readings. These may include repeated readings made in the doctor’s office as well as blood pressure measurements you performed at home.
High blood pressure, also called hypertension, is elevated pressure of the blood in the arteries. Hypertension results from two major factors that can occur independently or together.
Blood pressure is the force applied against the walls of the arteries as the heart pumps blood through the body. The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries.
High blood pressure makes the body's heart work harder, which over time can lead to damage in blood vessels throughout the body. Damaged blood vessels affect function in the heart, kidneys, brain, and eyes.
Two numbers are used to describe a blood pressure reading:
A third number, pulse pressure, is the difference between the systolic and the diastolic readings. It indicates stiffness and inflammation in blood vessel walls. The greater the difference between systolic and diastolic numbers, the greater the risk to health.
There are a number of ways to categorize or describe hypertension.
Doctors may also categorize hypertension based on what portion of the blood pressure reading is abnormal:
Blood Pressure Guidelines
Blood pressure is measured in millimeters of mercury (mm Hg). Blood pressure is categorized as:
|Blood Pressure Ranges|
Blood Pressure Category
Ranges for Most Adults (systolic/diastolic)
Normal Blood Pressure (systolic/diastolic)
Systolic below 120 mm Hg
Diastolic below 80 mm Hg
Systolic 120 - 139 mm Hg
Diastolic 80 - 89 mm Hg
(NOTE: 139/89 or below should be the minimum goal for everyone. People with heart disease or peripheral artery disease may benefit from levels of 130/80 or less. Blood pressure goals are being reexamined for African-Americans and for people with diabetes and chronic kidney disease.)
Mild Hypertension (Stage 1)
Systolic 140 - 159 mm Hg
Diastolic 90 - 99 mm Hg
Moderate-to-Severe Hypertension (Stage 2)
Systolic over 160 mm Hg or
Diastolic over 100 mm Hg
NOTE: If one of the measurements is in a higher category than the other, the higher measurement is usually used to determine the stage. For example, if systolic pressure is 165 (Stage 2) and diastolic is 92 (Stage 1), the person would still be diagnosed with Stage 2 hypertension. A high systolic pressure compared to a normal or low diastolic pressure should be a major focus of concern in most adults.
Blood Pressure in Children
For children, blood pressure readings are based on percentile ranges for a child's body size. Hypertension in children is defined as average systolic and diastolic readings that are greater than the 95th percentile for gender, age, and height on at least three occasions.
Prehypertension in children is diagnosed when average systolic or diastolic blood pressure levels are at least in the 90th percentile, but less than the 95th percentile. For adolescents as with adults, blood pressure readings greater than 120/80 are considered prehypertensive. Increasing rates of childhood obesity have led to higher rates of hypertension and prehypertension among children and adolescents.
Hypertension is referred to as primary (essential) when the doctor is unable to identify a specific cause. It is by far the most common type of high blood pressure. Primary hypertension may be due to a combination of genetic, environmental, and other factors.
Genetic factors. A number of genetic factors or interactions between genes play a major role in primary hypertension. Genes under investigation include:
Secondary hypertension is caused by an underlying medical condition or other factor (such as medications) that elevates blood pressure. Many different medical conditions are associated with secondary hypertension. These conditions can also make high blood pressure more difficult to control.
Diabetes. Hypertension is strongly associated with diabetes, both types 1 and 2. Kidney damage (diabetic nephropathy) is generally the cause of high blood pressure in people with diabetes.
Kidney disease. Kidney disease is the most common cause of secondary hypertension, particularly in older people. In addition to diabetic nephropathy, many other types of kidney diseases can cause hypertension. Renal artery stenosis involves the narrowing of the renal artery and is usually caused by atherosclerosis. Other types of kidney disease associated with hypertension are polycystic kidney disease and renal parenchymal disease.
Coarctation of the aorta. This is a birth defect that causes narrowing of the aorta, the main artery of the heart.
Endocrine disorders. Adrenal tumors (pheochromocytoma, aldosteronism), thyroid disorders, and Cushing syndrome can all cause secondary hypertension.
Medications. Many different prescription and over-the-counter drugs can temporarily raise blood pressure or worsen existing high blood pressure, including:
In the United States, about 1 in 3 adults has high blood pressure. Many people with high blood pressure don't know they have it.
About 30% of American adults have prehypertension (blood pressure ranges from 120 - 139/80 - 89 mm Hg). People who are diagnosed with prehypertension are at increased risk of developing high blood pressure.Age and Gender
Age is the major risk factor of hypertension. Men over age 45 and women over age 55 are at increased risk for high blood pressure. Over half of Americans over age 60 have hypertension. After age 65, high blood pressure affects more women than men. Hypertension is also becoming more common in children and teenagers. Among younger people, boys are at higher risk for high blood pressure than girls.Race and Ethnicity
Compared to Caucasians and other ethnic groups, African-Americans are more likely to have high blood pressure. More than 40% of African-American men and women have hypertension. (African-American women have a higher risk than African-American men.) High blood pressure tends to start at a younger age among African-Americans, is often more severe, and causes greater risks for premature death from heart attack, stroke, heart failure, and kidney failure.Family History
People with parents or other close relatives who have high blood pressure have an increased risk of developing it themselves.Obesity
About a third of people with high blood pressure are overweight. Even moderately obese adults have double the risk of hypertension than people with normal weights. Children and adolescents who are obese are at increased risk for high blood pressure when they reach adulthood.Obstructive Sleep Apnea
Obstructive sleep apnea, a disorder in which breathing halts briefly but repeatedly during sleep, is present in many people with hypertension. The relationship between sleep apnea and hypertension has been thought to be largely due to obesity. But studies are finding a higher rate of hypertension in people with sleep apnea regardless of their weight.Lifestyle Factors
Smoking. Cigarette smoking is a major risk factor for high blood pressure.
Sodium (salt) and potassium. Eating too much sodium (salt) can increase the risk for developing high blood pressure. Similarly, a diet that is too low in potassium can make the body accumulate too much sodium. Sodium and potassium are important regulators of fluid balance in cells.
Alcohol. Chronic heavy alcohol use can increase blood pressure. Women may be more sensitive than men to the blood pressure effects of alcohol.
Physical inactivity. A sedentary lifestyle and lack of physical activity can increase the risk of becoming overweight.
Stress. Mental and emotional stress can cause a temporary increase in blood pressure. Chronic stress can lead to engaging in unhealthy behaviors (overeating, smoking, alcohol use, lack of exercise) that contribute to high blood pressure.
High blood pressure, or hypertension, is a disorder characterized by chronically high blood pressure. It must be monitored, treated, and controlled by medication, lifestyle changes, or a combination of both.
High blood pressure places stress on several organs (called target organs), including the kidneys, eyes, and heart. The stress causes them to deteriorate over time.
High blood pressure contributes to 75% of all strokes and heart attacks. It is particularly deadly in African-Americans.
Combined with significantly high blood pressure, other risk factors can increase the likelihood of complications. These risk factors include:
High blood pressure is a major risk factor for hypertensive heart disease, the leading cause of illness and death from high blood pressure. Hypertensive heart disease is a group of complications that include:
About two-thirds of people who suffer a first stroke have moderate elevated blood pressure (160/95 mm Hg or above). Hypertensive people have up to 10 times the normal risk of stroke, depending on the severity of the blood pressure in the presence of other risk factors. Hypertension is also an important cause of silent cerebral infarcts, which are blockages in the blood vessels in the brain (mini-strokes) that may predict major stroke or progress to dementia over time.Diabetes and Kidney Disease
Diabetes. High blood pressure, and some of the medications used to treat it, can increase the risk for developing diabetes. There are strong biologic links between insulin resistance (with or without diabetes) and hypertension. It is unclear if one condition causes the other.
In general, people with diabetes should strive for blood pressure levels of less than 140/90 mm Hg (systolic/diastolic). For some people, especially younger people, a systolic blood pressure goal of less than 130 mm Hg may be appropriate. People with diabetes and high blood pressure need an individualized approach to drug treatment, based on their particular health profile.
The United States Preventive Services Task Force recommends screening for type 2 diabetes in all people with blood pressure higher than 135/80 mm Hg.
End-stage kidney disease. High blood pressure causes about 30% of all cases of end-stage kidney disease (referred to as end-stage renal disease, or ESRD). Only diabetes leads to more cases of kidney failure. People with diabetes and hypertension need to be monitored very closely for the development of kidney disease.Dementia
Isolated systolic hypertension may pose a particular risk for dementia, or memory loss.Eye Damage
High blood pressure can injure the blood vessels in the eye's retina, causing a condition called retinopathy.
Sexual dysfunction is more common and more severe in smokers and men with hypertension than it is in the general population. Although older drugs used to treat hypertension caused erectile dysfunction as a side effect, the disease process that causes hypertension is itself a major cause of erectile dysfunction.
Oral phosphodiesterase type 5 (PDE5) inhibitors -- such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) -- do not appear to pose a risk for most men who have both high blood pressure and erectile dysfunction. But men who have uncontrolled or unstable hypertension should not take these medications.
Men who take nitrate medications for heart disease cannot take erectile dysfunction pills.Pregnancy and High Blood Pressure
Many women who are likely to develop hypertension when they are older have their first elevated blood pressure readings during pregnancy. Elevated blood pressure readings generally show up early in pregnancy, before 16 - 20 weeks. These women often require antihypertensive medications during pregnancy and closer monitoring of themselves and the fetus. Continued hypertension after the pregnancy is also not uncommon.
Severe and sudden high blood pressure in pregnant women is one component of a condition called preeclampsia (also called toxemia) that can be very serious for both mother and child. Preeclampsia occurs in up to 10% of all pregnancies, usually in the third trimester of a first pregnancy, and resolves immediately after delivery. Other symptoms and signs of preeclampsia include protein in the urine, severe headaches, and swollen ankles.
The reduced supply of blood to the placenta can cause low birth weight and eye or brain damage in the fetus. Severe cases of preeclampsia can cause kidney damage, convulsion, and coma in the mother and can be lethal to both mother and child. Women at risk for preeclampsia (particularly those with existing hypertension) are monitored carefully for its presence. Both mother and fetus are monitored closely after a diagnosis. Blood pressure medications may be required.
Delivery is the main cure for preeclampsia. In severe cases, the obstetrician will need to induce pre-term birth.
High blood pressure increases slowly over the years. It is often called the "silent killer" because it usually produces no symptoms until vital organs are damaged, like the heart, brain, and kidneys.
Everyone, 18 years and older, should have their blood pressure measured on a regular basis. It is particularly important for anyone with risk factors to have their blood pressure checked regularly and to make appropriate lifestyle changes. Such recommendations are especially important for people who:
Malignant hypertension is very high blood pressure that comes on suddenly and quickly. The lower (diastolic) blood pressure reading, which is normally around 80 mm Hg, is often above 130 mm Hg. This rare disorder affects about 1% of people with high blood pressure, including both children and adults. It is more common in younger adults, especially African-American men.
Malignant hypertension is a life-threatening condition and must be treated immediately. People with uncontrolled hypertension or a history of heart failure are at increased risk for this crisis.
People should call a doctor immediately if these symptoms occur:
Most physical exams at the doctor's office include a blood pressure reading. People should not smoke, exercise, or drink caffeinated beverages within 30 minutes before their blood pressure measurement.Measuring Blood Pressure
The standard instrument used to measure blood pressure is called a sphygmomanometer, more often referred to as a blood pressure cuff. Measurements are given as units of mercury, which was used to fill the central column in standard sphygmomanometers for many years. Modern devices do not use mercury.
Decisions on starting or increasing medications should be based on multiple blood pressure readings, taken at both the doctor's office and at home.
Although this test has been used for more than 90 years, it is not completely accurate or sensitive. The following factors can cause a falsely low pressure reading:
Falsely high pressure readings can result from:
Blood pressure readings taken by a doctor are more likely to be higher than readings measured at home. This can be due to "white coat hypertension," which is blood pressure that is only elevated during a doctor's office visit. People with white coat hypertension have:
These people may require additional blood pressure monitoring.Ambulatory Monitoring
Doctors may ask some people to use a special ambulatory monitoring device for a 24-hour period. The device checks blood pressure about every 15 - 30 minutes during the day and night and provides a read-out of blood pressure measurements for the doctor. Ambulatory monitoring may be used for people who have borderline high blood pressure or for those who have had difficulty keeping their blood pressure under control. It can also help distinguish between true and white coat hypertension and it can detect masked hypertension (readings that are normal in a doctor's office but high during daily life). Ambulatory monitoring can also be helpful for diagnosing children with suspected high blood pressure.Home Monitoring
The American Heart Association (AHA) recommends that all people with high blood pressure monitor their blood pressure at home on a regular basis. In addition to other benefits, home monitoring can help show if blood pressure medications are working.
The AHA recommends:
Blood pressure variations at home. In general, everyone's blood pressure varies throughout the day. In monitoring at home, it is important to note that blood pressure is usually highest from morning to mid-afternoon. Upon waking, blood pressure in most people typically increases suddenly. Early morning is the highest risk period for heart attack and stroke.
Blood pressure normally dips to its lowest level during sleep, although some people (particularly postmenopausal women) have a condition called non-dipper hypertension, in which blood pressure does not fall at night.
Physical Examination for Complications of Hypertension
If your blood pressure is elevated, the doctor will:
If hypertension is suspected, your doctor may ask about:
If a physical examination indicates hypertension, additional tests may help determine whether organ damage is present.
Blood tests and urinalysis. These tests are performed to check for a number of factors, including:
Measuring blood levels of the protein creatinine, for example, is important for all hypertensive people in order to determine kidney damage.
Tests to evaluate the heart. These tests include:
Tests to evaluate the kidneys. These tests include:
People with hypertension should work with their doctors to set blood pressure goals based on their individual risk factors, including:
The decision to start or increase blood pressure medications should not be based on a single blood pressure reading in the doctor's office, but on repeated readings. Your doctor may ask you for a list of your home blood pressure readings to help provide a more accurate estimate of your true blood pressure. It may be necessary to check blood pressure as many as five or six times to get the best estimate.
Drug treatment must be individualized. In some people, a single-drug regimen can control mild to moderate hypertension. But the latest guidelines recommend combination therapy with two or more drugs if a person's blood pressure remains above 140/90 mm Hg despite lifestyle changes (diet, exercise, and weight control).
Each drug has specific benefits. But their effects may vary depending on the individual. The major anti-hypertensive medications fall into the following 5 categories:
Side effects and problems in compliance. One of the most difficult issues that people face is that the treatment may make them feel worse than the disease, which usually has no symptoms. Whatever the difficulties, compliance with a drug and lifestyle program is worth the effort. It is very important to discuss any medication concerns with your doctor. If your current blood pressure drugs are causing uncomfortable side effects, your doctor may adjust your dosages or combinations.
Withdrawal from anti-hypertensive medications. People whose blood pressure has been well-controlled and who are able to maintain a healthy lifestyle may be able to withdraw from medications. They should do so in a step-down manner (gradual reduction) and be monitored regularly. Stopping too quickly can have adverse effects, including serious effects on the heart. People who are most likely to stop using medications include
People over 75 years old may have more trouble than younger adults maintaining normal blood pressure after withdrawal.Treatment of Resistant Hypertension
Some people are unable to meet target blood pressure goals despite consistently following a treatment plan that includes three or more medications. Factors that contribute to treatment resistant hypertension include:
Treating any underlying medical condition is important for helping control blood pressure. People should be sure to adhere to healthy lifestyle changes and may require modifications to their drug regimens. Those with severe resistant hypertension should consult with a doctor who specializes in treating high blood pressure.Treatment of Older Adults
High blood pressure is very common in older adults and can be challenging to control. In general, older adults usually have an elevated systolic blood pressure and a normal or low diastolic blood pressure, a condition known as isolated systolic hypertension.
Medications can be very effective for controlling high blood pressure in older adults, even in those over age 80. The choice of medications will depend in part on a person's history of other heart problems. Blood pressure drugs prescribed for older people are generally started at the lowest dose and then gradually increased as necessary. As with all people with high blood pressure, lifestyle changes are an essential component of treatment.
Older adults should have their blood pressure monitored on a regular basis. Blood pressure readings should be taken while in a standing position, as well as while seated.Treatment of Children
Results of studies evaluating outcomes of children with hypertension suggest that early abnormalities, including an enlarged heart and abnormalities in the kidney and eyes, may occur even in children with mild hypertension. Children and adolescents with hypertension should be monitored and evaluated for any early organ damage. Secondary hypertension (high blood pressure due to another disease or drug) is more common in children than adults.
Children with high blood pressure should first be treated with lifestyle changes, including:
If blood pressure is not controlled with lifestyle changes, drug treatment may be required.
Healthy lifestyle changes are an important first step for lowering blood pressure. Current guidelines recommend that people should:
In general, everyone should restrict their sodium intake to no more than 2,300 mg a day (less than 1 teaspoon of salt). This is particularly important for people over age 50, all African-Americans, and everyone with high blood pressure. The American Heart Association recommends that people with heart disease risk factors limit sodium intake to no more than 1,500 mg a day (about ½ teaspoon). Sodium restriction lowers blood pressure and also helps protect against heart failure and heart disease.
Some people are salt sensitive. This means their blood pressure responds much more to salt than other people. People with salt sensitivity have a higher than average risk of developing high blood pressure, as well as other heart problems. Sodium restriction is particularly important for people with salt sensitivity, which includes:
Salt substitutes such as Nu-Salt and AlsoSalt are available. But they can be risky for people with kidney disease or those who take blood pressure medications that can cause potassium retention.
Some tips for lowering your salt and sodium intake include:
A potassium-rich diet may help reduce blood pressure. Potassium-rich foods include:
The recommended daily intake of potassium is 3,500 mg a day for people without risk factors for excess potassium levels.
Some people may need to take potassium supplements. However, people who take medications that limit the kidney's ability to excrete potassium, such as ACE inhibitors, digoxin, or potassium-sparing diuretics, should not take potassium supplements and should be aware of excess potassium in their diet.DASH Diet
The salt-restrictive DASH diet (Dietary Approaches to Stop Hypertension) is proven to help lower blood pressure, and may have additional benefits for preventing heart disease and stroke. Effects on blood pressure are sometimes seen within a few weeks. This diet is not only rich in important nutrients and fiber but also includes foods that contain far more potassium (4,700 mg/day), calcium (1,250 mg/day), and magnesium (500 mg/day), and much less sodium (salt) than the typical American diet.
DASH diet recommendations include:
Fiber. Increasing fiber in the diet may help reduce blood pressure levels.
Fish oil and omega-3 fatty acids. The omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaneoic acids (EPA) are found in oily fish. Studies indicate that omega-3s from diet may have benefits for many medical conditions, including heart disease and hypertension. They help keep blood vessels flexible and may help protect the nervous system. Omega-3 fatty acids are also available in supplement form. But eating fish protects the heart more than taking fish oil supplements.
Calcium. Hypertension increases calcium loss from the body. Calcium regulates the tone of the smooth muscles lining blood vessels. Studies have found that people who consume adequate dietary calcium on a daily basis have lower blood pressure than those who do not.
Consuming too much dietary calcium may have a negative effect: Some studies indicate that excess calcium intake (from dietary or supplement sources) may increase blood pressure and other heart disease risk factors.
Even modest weight loss in overweight people, particularly in the abdominal area, can immediately lower blood pressure. When accompanied by salt restriction, weight loss may allow people with mild hypertension to safely reduce or go off medications. The benefits of weight loss on blood pressure are long-lasting.Exercise
Regular exercise helps keep arteries elastic, even in older people. This ensures blood flow and normal blood pressure. Doctors recommend at least 30 minutes of exercise on most days.
High-intensity exercise may not lower blood pressure as effectively as moderate intensity exercise and may be dangerous in people with hypertension. Older people and those with uncontrolled hypertension or other serious medical conditions should check with their doctors before starting an exercise program.
Everyone should quit smoking, especially people with high blood pressure and other heart disease risk factors.Good Sleep Habits
Certain sleep disorders, especially sleep apnea, are associated with hypertension. Even chronic, insufficient sleep may raise blood pressure in people with hypertension, placing them at increased risk of heart disease and death. Stress hormone levels increase with sleeplessness, which can activate the sympathetic nervous system, a strong player in hypertension.
People who have chronic insomnia or other severe sleep disturbances may want to consult a doctor who specializes in sleep disorders. People with hypertension who are habitually poor sleepers should consider long-acting blood pressure medications to help counteract the increase in blood pressure that occurs in the early morning hours.Stress Reduction
Stress reduction may help blood pressure control. Yoga, Tai chi, and relaxation techniques such as meditation may be beneficial.
Several classes of drugs are used to treat hypertension.Diuretics
Diuretics help the kidneys get rid of excess salt and water. Thiazide diuretics are the mainstays of anti-hypertensive therapy and are often the first type of drug selected for most people with hypertension. They are also especially helpful for treating people with heart failure, people with isolated systolic hypertension, the elderly, and African-Americans. (African-Americans are more likely to be salt-sensitive, so they respond well to these drugs.) They also work well for people with diabetes. Diuretics are often used in combination with other antihypertensive drugs.
There is strong evidence that diuretics work just as well as newer drugs in lowering blood pressure and are more effective in preventing heart failure, heart attack, and stroke.
The 3 main types of diuretics include:
Loop and thiazide diuretics reduce the body's supply of potassium (hypokalemia), which, if left untreated, increases the risk for arrhythmias. Arrhythmias are heart rhythm disturbances that can lead to cardiac arrest, although they rarely do. If you experience reduced potassium, your doctor will prescribe a lower dose of your current diuretic, recommend potassium supplements, or switch to a potassium-sparing diuretic either alone or in combination with a thiazide.
Common diuretic side effect symptoms include:
Beta blockers help slow your heart rate and lower blood pressure. They are usually used in combination with other drugs such as ACE inhibitors and diuretics. Beta blockers are more likely to be used to treat hypertension in people with angina, previous heart attack, arrhythmias with fast heart rates, or migraine headaches. With careful use, they can be beneficial for people with heart failure.
Brands. Propranolol (Inderal), acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), carteolol (Cartrol), metoprolol (Lopressor), nadolol (Corgard), penbutolol (Levatol), pindolol (Visken), carvedilol (Coreg), timolol (Blocadren), and nebivolol (Bystolic). The drugs may differ in their effects and benefits. With the exception of nebivolol, all of these drugs are available in generic form.
When taking beta blockers:
Common side effect symptoms of beta blockers include:
Check with your doctor about any side effects. Do NOT stop taking these drugs on your own.ACE Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors widen blood vessels and decrease the workload of the heart. They treat high blood pressure and can also help protect the heart and kidneys.
people with heart failure or an enlarged left ventricle, previous heart attack, diabetes, or kidney disease are considered particularly good candidates for ACE inhibitors as part of treatment for high blood pressure.
Aspirin is recommended for reducing the risk of cardiac problems in people with heart disease, and can safely be used in combination with ACE inhibitors, particularly at lower dosages of aspirin (75 - 81 mg).
Brands. ACE inhibitors include captopril (Capoten, generic), enalapril (Vasotec, generic), quinapril (Accupril, generic), benazepril (Lotensin, generic), ramipril (Altace, generic), perindopril (Aceon, generic), and lisinopril (Prinivil, Zestril, generic).
Common side effect symptoms of ACE inhibitors include:
Uncommon Side Effects of ACE Inhibitors.
People who have difficulty tolerating ACE inhibitor side effects are usually switched to an angiotensin-receptor blocker (ARB).Angiotensin-Receptor Blockers (ARBs)
ARBs, also known as angiotensin II receptor antagonists, are similar to ACE inhibitors in their ability to widen blood vessels and lower blood pressure. They may have fewer or less-severe side effects than ACE inhibitors, especially coughing, and are sometimes prescribed as an alternative to ACE inhibitors. In general they are prescribed to people who cannot tolerate or did not respond to ACE inhibitors.
Brands. Losartan (Cozaar, Hyzaar, generic), olmesartan (Benicar) candesartan (Atacand), telmisartan (Micardis), eprosartan (Teveten), irbesartan (Avapro), valsartan (Diovan), and azilsartan (Edarbi).
A combination medication containing candesartan and the diuretic hydrochlorothiazide (Diovan HCT, Atacand HCT) is also available. Exforge HCT is a triple-combination medication that combines in one pill valsartan along with the calcium-channel blocker amlodipine and the diuretic hydrochlorothiazide. Tribenzor combines in one pill olmesartan, amlodipine, and hydrochlorothiazide.
NOTE: ARBs should not be used during pregnancy.
Calcium-Channel Blockers (CCBs)
Calcium-channel blockers (CCBs), also known as calcium antagonists, help relax blood vessels. Along with diuretics, CCBs may work better than other drug classes for lowering blood pressure in African-Americans. Recent research indicates that newer types of drugs (CCBs, ACE inhibitors) may be a better treatment option for some people than older drugs (especially beta blockers).
Brands. Diltiazem (Cardizem, Dilacor), amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc), verapamil (Calan, Isoptin, Verelan), nisoldipine (Sular), nicardipine (Cardene), and nifedipine (Adalat, Procardia).
All these prescription medications are available as generics. For people who have both high blood pressure and high cholesterol, Caduet combines in one pill amlodipine and the statin drug atorvastatin.
Alpha blockers such as doxazosin (Cardura, generic), prazosin (Minipress, generic), and terazosin (Hytrin, generic) help widen small blood vessels. They are generally not used as first-line drugs for high blood pressure, but are prescribed if other drugs do not work or as add-on medication.Vasodilators
Vasodilators help open blood vessels by relaxing muscles in the blood vessel walls. These drugs are usually used in combination with a diuretic or a beta blocker. They are rarely used by themselves.
Brands. Hydralazine (Apresoline, generic), clonidine (Catapres, generic), and Minoxidil (Loniten, generic).
Some of these drugs should be used with caution or not at all in people who have angina or who have had a heart attack.Other Drugs
Aliskiren (Tekturna). Aliskiren (Tekturna, Amturnide) is a new kind of antihypertensive drug called a direct renin inhibitor. It blocks renin, a kidney enzyme associated with high blood pressure. Aliskiren is also available in the 2-in-1 combination pills Tekturna HCT (aliskiren and the diuretic hydrochlorothiazide) and Tekamlo (aliskiren and the calcium channel blocker amlodipine). Aliskiren is prescribed either alone or in combination with other blood pressure medications. However, people with diabetes or kidney impairment should not take aliskiren along with ACE inhibitors or ARBs because of increased risk for kidney damage and other problems. Aliskiren should not be used during pregnancy as it can cause injury or death to the fetus.
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Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.