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Treatments and drugs
By Mayo Clinic staffYour blood pressure treatment goal depends on how healthy you are.
| Blood pressure treatment goals* | |
|---|---|
| 140/90 mm Hg or lower | If you are a healthy adult |
| 130/80 mm Hg or lower | If you have chronic kidney disease, diabetes or coronary artery disease or are at high risk of coronary artery disease |
| 120/80 mm Hg or lower | If your heart isn't pumping as well as it should (left ventricular dysfunction or heart failure) or you have severe chronic kidney disease |
*Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need treatment (medications) to reach that level.
If you're an adult age 80 or older and your blood pressure is very high, your doctor may set a target blood pressure goal for you that's slightly higher than 140/90 mm Hg.
Changing your lifestyle can go a long way toward controlling high blood pressure. But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure. Which category of medication your doctor prescribes depends on your stage of high blood pressure and whether you also have other medical problems.
Medications to treat high blood pressure
- Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic.
- Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in blacks or in older adults — but they're effective when combined with a thiazide diuretic.
- Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.
- Angiotensin II receptor blockers (ARBs). These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels.
- Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks and older adults than do ACE inhibitors or beta blockers alone. A word of caution for grapefruit lovers, though. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned about interactions.
- Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs.
If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:
- Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
- Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
- Central-acting agents. These medications prevent your brain from signaling 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.
Once your blood pressure is under control, your doctor may have you take a daily aspirin to reduce your risk of cardiovascular disorders.
To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often work better than one. Sometimes finding the most effective medication — or combination of drugs — is a matter of trial and error.
Lifestyle changes to treat high blood pressure
No matter what medications your doctor prescribes to treat your high blood pressure, you'll need to make lifestyle changes to lower your blood pressure. These changes usually include eating a healthier diet with less salt (the Dietary Approaches to Stop Hypertension, or DASH, diet), exercising more, quitting smoking and losing weight.
Resistant hypertension: When your blood pressure is difficult to control
If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension. Resistant hypertension is blood pressure that's resistant to treatment. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension.
Having resistant hypertension doesn't mean your blood pressure will never get lower. In fact, if you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective.
Your doctor or hypertension specialist can evaluate whether the medications and doses you're taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses.
In addition, you and your doctor can review medications you're taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take.
If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medication, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't change your treatment without your doctor's guidance.
- Chobanian AV, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. New England Journal of Medicine. 2003;289:2560.
- Why blood pressure matters. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/WhyBloodPressureMatters/Why-Blood-Pressure-Matters_UCM_002051_Article.jsp. Accessed June 19, 2012.
- Aronow WS, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly. Journal of the American College of Cardiology. 2011;57:2037.
- Kaplan NM, et al. Treatment of hypertension in blacks. http://www.uptodate.com/home/. Accessed June 19, 2012.
- Rosen CJ, et al. The nonskeletal effects of vitamin D: An Endocrine Society scientific statement. Endocrine Reviews. 2012;33:456.
- Kaplan NM, et al. Prehypertension. http://www.uptodate.com/home/. Accessed June 19, 2012.
- Calhoun DA, et al. Resistant hypertension: Diagnosis, evaluation and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;117:e510.
- Mann JFE. Choice of therapy in essential hypertension: Recommendations. http://www.uptodate.com/home/. Accessed June 19, 2012.
- Lopez L, et al. Lifestyle modification counseling for hypertensive patients: Results from the National Health and Nutrition Examination Survey 1999-2004. American Journal of Hypertension. 2009;22:325.
- Tseng C, et al. A predictive model for risk of prehypertension and hypertension and expected benefit after population-based life-style modification (KCIS No. 24). American Journal of Hypertension. 2012;25:171.
- Your guide to lowering blood pressure with DASH. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/. Accessed June 19, 2012.
- Appel LJ, et al. Dietary approaches to prevent and treat hypertension: A scientific statement from the American Heart Association. Hypertension. 2006;47:296.
- Pandic S, et al. Device-guided breathing exercises in the treatment of hypertension - perceptions and effects. CVD Prevention and Control. 2008;3:163.
- Natural medicines in the clinical management of hypertension. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 19, 2012.
- Home blood pressure monitoring. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/SymptomsDiagnosisMonitoringofHighBloodPressure/Home-Blood-Pressure-Monitoring_UCM_301874_Article.jsp. Accessed June 19, 2012.
- Dietary Guidelines for Americans, 2010. U.S. Department of Health and Human Services. http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm. Accessed June 19, 2012.
- U.S. Preventive Services Task Force. Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine. 2007;147:783.
- Mayo Clinic statement: Aliskiren safety concern. Mayo Pharmaceutical Formulary Committee. http://mayoweb.mayo.edu/mfpfc-cmte/1112aliskirenStatement.pdf. Accessed June 19, 2012.
- Novartis announces termination of ALTITUDE study with Rasilez/Tekturna in high-risk patients with diabetes and renal impairment. Novartis International AG. http://www.novartis.com/downloads/newsroom/rasilez-tekturna-information-center/20111220-rasilez-tekturna.pdf. Accessed June 19, 2012.
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