A doctor shares 9 common blood pressure medications and how each works

Medically reviewed by Jeffrey S. Lander, MD

Key Takeaways

• Combining blood pressure medications, such as a long-acting calcium channel blocker with an ACE inhibitor or ARB, is often more effective than increasing the dose of one drug.
• The choice of blood pressure medication depends on the severity of hypertension and individual health needs.

Many medications can lower—not cure—high blood pressure. They are tailored to your response, side effects, and other health factors.

1. Diuretics

Diuretics (water pills) increase the amount of sodium and water excreted into the urine by the kidneys. Diuretics are thought to lower blood pressure mainly by reducing fluid volume in the blood vessels.

Thiazide diuretics

• Indapamide
• Metolazone
• Microzide (hydrochlorothiazide)
• Thalitone (chlorthalidone), also sold as Tenoretic (chlorthalidone and atenolol)

Potassium-sparing diuretics

• Aldactone (spironolactone)
• Dyrenium (triamterene)
• Inspra (eplerenone)
• Midamor (amiloride hydrochloride)

Loop diuretics

• Bumex (bumetanide)
• Edecrin (ethacrynic acid)
• Lasix (furosemide)
• Torsemide

Carbonic anhydrase inhibitors

• Acetazolamide

Aldosterone receptor antagonists

• Aldactone (spironolactone)
• Inspra (eplerenone)
• Kerendia (finerenone)

Possible side effects of diuretics include:

• Frequent urination
• Lightheadedness
• Fatigue
• Bowel changes
• Hypokalemia (common with thiazide and loop diuretics)
• Erectile dysfunction

2. Angiotensin-Converting Enzyme (ACE) Inhibitors

The angiotensin-converting enzyme (ACE) inhibitors can lower blood pressure by dilating the arteries.

Popular ACE inhibitors include:

• Altace (ramipril)
• Captopril
• Fosinopril
• Lotensin (benazepril)
• Perindopril
• Quinapril
• Trandolapril
• Vasotec, also sold as Vaseretic (enalapril)
• Zestril (lisinopril)

Side effects of ACE inhibitors may include:

• Dizziness
• Chronic cough
• Loss of sense of taste
• Hyperkalemia 

3. Angiotensin II Receptor Blockers (ARBs)

Angiotensin II receptor blockers (ARBs) also reduce blood pressure by dilating the arteries. Due to their better efficacy and fewer adverse effects, ARBs are generally superior to ACE inhibitors.

Options include:

• Atacand (candesartan)
• Avapro (irbesartan)
• Benicar (olmesartan)
• Cozaar (losartan)
• Diovan (valsartan)
• Edarbi (azilsartan)
• Micardis (telmisartan)

Side effects of ARBs may include:

• Dizziness
• Allergic reaction
• Hyperkalemia
• Kidney damage

4. Calcium-Channel Blockers

Calcium channel blockers can reduce blood pressure by dilating the arteries and, in some cases, reducing the force of the heart's contractions.

Examples of calcium channel blockers include:

• Cardene (nicardipine)
• Cardizem, also sold as Tiazac (diltiazem)
• Felodipine
• Isradipine
• Norvasc (amlodipine)
• Procardia XL (nifedipine)
• Sular (nisoldipine)
• Verelan (verapamil)

Side effects of calcium channel blockers may include:

• Constipation
• Swelling of the legs
• Headache
• Dizzines

First-Line Treatments

For most people with high blood pressure, the preferred first-line medications are thiazide diuretics, ACE inhibitors, ARBs, and calcium-channel blockers.

5. Beta Blockers

Beta-blockers are no longer considered a first-line, single-drug therapy for hypertension unless a patient has ischemic heart disease, heart failure, or arrhythmias. These drugs block the effect of adrenaline on the cardiovascular system, slow the heart rate, and reduce stress on the heart and the arteries.

Some beta-blockers include:

• Acebutolol
• Betaxolol
• Bystolic (nebivolol)
• Inderal, Inderal LA (propranolol)
• Lopressor, also sold as Toprol (metoprolol)
• Nadolol
• Pindolol
• Tenormin (atenolol)
• Timolol
• Toprol-XL (metoprolol succinate)
• Ziac (bisoprolol)

Beta-blockers' side effects may include:

• Worsening of dyspnea in people with chronic obstructive pulmonary disease (COPD) or asthma
• Sexual dysfunction
• Fatigue
• Depression
• Worsening of symptoms in people with peripheral artery disease

Combined Alpha and Beta-Blockers

In addition to blocking beta receptors, combined alpha and beta-blockers can also block alpha receptors. These medications can further lower blood pressure and heart rate.

Examples of combined alpha and beta-blockers include:

• Coreg (carvedilol)
• Labetalol

6. Alpha-Blockers

Alpha-blockers help reduce blood pressure by relaxing the muscle tone of blood vessel walls.

Examples of alpha-blockers include:

• Cardura (doxazosin)
• Minipress (prazosin)
• Tezruly (terazosin hydrochloride)

Side effects include:

• Fast heart rate
• Dizziness
• Low blood pressure
• Weakness

7. Vasodilators

Vasodilators help relax the muscle tone of the vascular walls, allowing the vessels to widen so that blood can flow through better.

Examples of vasodilators include:

• Hydralazine
• Minoxidil

Side effects of vasodilators may include:

• Headache
• Constipation
• Swelling in the lower legs
• Fast heart rate
• Excess hair growth (only with minoxidil)

8. Alpha-2-Receptor Agonists

These drugs stimulate alpha-2 adrenergic receptors in the central nervous system, decreasing sympathetic nervous system activity and causing a drop in blood pressure and heart rate.

Examples of alpha-2-receptor agonists include:

• Catapres, also sold as Duraclon and Nexiclon XR (clonidine)
• Javadin (clonidine hydrochloride) oral solution
• Intuniv, also sold as Tenex (guanfacine)
• Methyldopa

Side effects of alpha-2-receptor agonists may include:

• Dry mouth fatigue
• Headache
• Sexual dysfunction
• Drowsiness or dizziness (only with methyldopa)

9. Direct Renin Inhibitors

Direct renin inhibitors reduce blood pressure by inhibiting renin activity, which normally constricts blood vessels.

Aliskiren is the only direct renin inhibitor available.

Side effects of direct renin inhibitors may include:

• Diarrhea
• Stomach pain
• Headache
• Dizziness

Should You Combine Drugs to Lower Your Blood Pressure?

Research shows that combining blood pressure medications is about five times more effective than doubling the dose of one drug.

The best results—like lower risk of stroke or heart attack—often come from pairing a long-acting calcium channel blocker with an ACE inhibitor or ARB, which is why many healthcare providers start with this combo.

For people with more severe hypertension, guidelines recommend starting with two types of medications combined in a single pill. People with less-severe elevation may start with a single medication and add another if needed.

Single-pill combinations (single tablets that contain two or more medications) include:

• Aldactazide (spironolactone and hydrochlorothiazide)
• Amiloride and hydrochlorothiazide (available as generic)
• Hydra-Zide (hydralazine and hydrochlorothiazide)
• Hyzaar (losartan and hydrochlorothiazide)
• Lopressor HCT (metoprolol and hydrochlorothiazide)
• Lotensin HCT (benazepril and hydrochlorothiazide)
• Lotrel (amlodipine and benazepril)
• Maxzide (triamterene and hydrochlorothiazide)
• Tenoretic (atenolol and chlorthalidone)
• Verapamil extended-release and trandolapril
• Zestoretic (lisinopril and hydrochlorothiazide)
• Ziac (bisoprolol and hydrochlorothiazide)
• Vaseretic (enalapril and hydrochlorothiazide)

Takeaway

In May 2026, Baxfendy (baxdrostat) was approved to treat uncontrolled high blood pressure in combination with other medications. Baxfendy inhibits aldosterone synthase, which stimulates water and sodium retention, leading to high blood pressure. Clinical trials found that the treatment lowered systolic blood pressure by 15.7 mmHg.

When Do You Need to Take Blood Pressure Medications?

The extent of your high blood pressure helps determine which treatment course may be best for you. Blood pressure (BP) is measured in millimeters of mercury (mmHg).

If the systolic (top number) and diastolic (bottom number) blood pressure differ, the higher one determines the stage. Most treatment goals involve less than 120/80 mmHg blood pressure.

In general, medication is recommended for people with stage 2 hypertension and those with stage 1 who are at higher risk of an event like a heart attack or stroke. However, deciding whether or not to start medication for your high blood pressure requires a discussion with your healthcare provider.

Read the original article on Verywell Health