High Blood Pressure: Condition Management, Medications, & Treatment Options

While there is no cure for high blood pressure,¹ you might be wondering about how to lower blood pressure. Blood pressure management includes:

• Lifestyle changes
• Medications
• Monitoring blood pressure

Blood pressure management is an ongoing effort in people living with high blood pressure.¹ Managing high blood pressure can improve the quality of life and reduce the risk of complications from high blood pressure.

Lifestyle Changes to Help Lower Blood Pressure

You can help lower your blood pressure by making changes to the way you live your life.^{1, 2}

Dietary Changes for High Blood Pressure

Eating heart-healthy foods can lower your blood pressure and reduce your risk of complications from high blood pressure.³ High-quality nutrition comes from healthy food sources. Healthy food sources include fruits, vegetables, whole grains, low-fat dairy products, skinless poultry and fish, and nuts and legumes.

Heart-healthy eating also involves limiting your intake of some foods.³ You should limit your intake of foods that have saturated and trans fats because they can increase your cholesterol. You should also limit the amount of red meat, sweets, and sugar-sweetened drinks that you consume.

Foods that are high in sodium can increase your blood pressure.³ Sodium in foods usually comes in the form of salt.⁴ Sodium is especially high in packaged, processed foods. Lower your sodium intake by:

• Using salt alternatives (e.g., lemon juice, spices, herbs, flavorings) or salt substitutes
• Reading the labels when you buy packaged or prepared foods
• Choosing low-sodium or lower-sodium foods

Physical Activity

Regular physical activity can lower your blood pressure.⁵ It can also help to manage your body weight and stress level. Being physically active can mean anything from taking a walk with a friend to taking a fitness class. Whichever ways you choose to move your body, it’s important to do activities that are appropriate for your fitness level and things that you like to do. Start gradually and increase your activity level over time, especially if you haven’t been active in a while.

Weight Management

Weight management can involve losing weight and/or maintaining a healthy weight.⁶ Eating well and being physically active are ways to do both. For patients who are overweight or for patients with obesity, losing weight can help reduce blood pressure. If you need to lose weight, talk to a healthcare provider about healthy ways to do it.

Reducing Alcohol Consumption

Drinking too much alcohol can increase your blood pressure.⁷ Reducing the amount of alcohol you drink can help manage your blood pressure.

Avoiding Smoking and Other Tobacco Use

Smoking temporarily increases blood pressure.⁸ Smoking and exposure to secondhand smoke also increase the risk of more serious and permanent effects on the arteries. These changes to the arteries increase the risk of heart attack and stroke just like high blood pressure can also increase these risks. Avoid all forms of tobacco and secondhand smoke to live a heart-healthy lifestyle.

Medications for High Blood Pressure

Medications for high blood pressure are an important part of blood pressure management.^{9, 10} Medications for high blood pressure are also called antihypertensives.¹⁰

If you have increased blood pressure (120-129/<80 mm Hg), lifestyle changes might be enough to lower your blood pressure into the normal range.² But for most patients with high blood pressure (at least 130/80 mm Hg), lifestyle changes will not be enough to lower the blood pressure into the normal range.^{2, 11} Patients with high blood pressure will usually require at least 1 high blood pressure medication to reach their blood pressure goals.² Some patients may require 2 or more high blood pressure medications.^{2, 9}

Types of High Blood Pressure Medications

High blood pressure medications can be divided into groups.¹⁰ These groups are sometimes called classes. Medications in each class generally work the same way and have similar side effects. Healthcare providers usually prescribe high blood pressure medications from 1 of 4 classes of medications for most patients to start.² These are:

• Thiazide diuretics
• Calcium channel blockers (CCBs)
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)

Below is an overview of each of these classes and some common names of medications in each class. You will also find some information on how these medications work to help lower blood pressure and some of their common side effects.

Thiazide Diuretics

Common thiazide or thiazide-type diuretics include:^{2, 10}

• Chlorthalidone
• Hydrochlorothiazide
• Metolazone
• Indapamide

Thiazide diuretics work to lower blood pressure by helping the body get rid of extra sodium and water.¹⁰ These medications can also decrease the amount of potassium in the body, which might make you feel weak or tired or have leg cramps.

Calcium Channel Blockers

Common calcium channel blockers include:^{2, 10}

• Amlodipine
• Diltiazem
• Felodipine
• Isradipine
• Nicardipine
• Nifedipine
• Nisoldipine
• Verapamil

Calcium channel blockers work to lower blood pressure by reducing how forcefully the heart contracts and by relaxing and opening up blood vessels to allow for more blood flow.¹⁰ Common side effects include feeling your heart beat fast, swollen ankles, constipation, headache, and dizziness.

Angiotensin-Converting Enzyme (ACE) Inhibitors

Common ACE inhibitors include:^{2, 10}

• Benazepril
• Captopril
• Enalapril
• Fosinopril
• Lisinopril
• Moexipril
• Perindopril
• Quinapril
• Ramipril
• Trandolapril

ACE inhibitors work to lower blood pressure by helping the body produce less of a substance that makes the blood vessels narrower.¹⁰ Blood vessels can then relax and open up to allow for more blood flow. Some patients might experience a chronic, dry cough while taking an ACE inhibitor. ACE inhibitors can also cause a skin rash or loss of taste.

Angiotensin II Receptor Blockers

Common angiotensin receptor blockers include:^{2, 10}

• Candesartan
• Eprosartan
• Irbesartan
• Losartan
• Telmisartan
• Valsartan

Angiotensin II receptor blockers work to lower blood pressure by blocking the effects of a substance that makes the blood vessels narrower.¹⁰ The blood vessels can then remain widened and allow for more blood flow. Angiotensin II receptor blockers can cause occasional dizziness.

Other High Blood Pressure Medication Classes

There are other classes of high blood pressure medications that are prescribed less often or only in special situations or for certain patients.^{2, 10} These classes include:

• Other diuretics (loop, potassium sparing, and aldosterone antagonists)
• Beta-blockers
• Direct renin inhibitor
• Alpha-1 blockers
• Alpha-2 receptor agonists and central agonists
• Combined alpha and beta-blockers
• Peripheral adrenergic agonists
• Vasodilators

Tips for Managing High Blood Pressure Medications

Most people with high blood pressure will have to take medications throughout their lives.⁹ To be successful, be sure to:

1. Work with your healthcare provider to find the right medications and doses to help you reach your blood pressure goal.^{9, 11}
2. Understand that it might take some time and/or more than one medication to reach your blood pressure goal.¹¹
3. Talk to your healthcare provider about any concerns, such as medication costs or side effects.¹¹
4. Tell all of your healthcare providers about all of the over-the-counter medications, prescription medications, and supplements that you take.¹¹1
5. Take your medications exactly as prescribed.¹¹

Monitoring Blood Pressure

People diagnosed with high blood pressure should monitor their blood pressure regularly between appointments.^{1, 12} This can be done at home or at a pharmacy with a blood pressure monitor.¹² Home monitoring does not take the place of regular appointments with a healthcare provider.¹³ Instead, home monitoring helps the healthcare provider know if a treatment is working. It also helps you to know your usual blood pressure numbers so you’re able to notice changes and patterns.¹

Choosing a Blood Pressure Monitor for Home Use

Use an upper-arm (bicep), cuff-style automatic blood pressure monitor for home monitoring.¹³ Be sure to choose a monitor that has a cuff that fits your arm. Wrist and finger blood pressure monitors are not as accurate and are not recommend.

Your healthcare provider can help you choose a blood pressure monitor that gives accurate results.¹³ Bring your monitor to your next office visit. The healthcare provider can help you make sure you’re using it correctly. They can also make sure that the results it’s giving you match the results that the office equipment gives. You should bring your blood pressure monitor to the healthcare provider’s office once a year to make sure it continues to give you accurate results.

Measuring Blood Pressure at Home: Tips for Success

Monitoring your blood pressure at home is very similar to having it checked in the office.¹³ Before checking your blood pressure:

• Avoid caffeine, exercise, and smoking within 30 minutes of your measurement
• Use the bathroom prior to measurement
• Relax quietly for 5 minutes

When you’re ready to check your blood pressure, be sure to sit with your feet flat on the floor, your back supported, and your arm resting on a table at the level of the heart.¹³ Make sure that your clothes are out of the way of the arm cuff.

Taking measurements daily at the same time each day is ideal, for example once in the morning and once in the evening.¹³ Each time you check your blood pressure, take 2 or 3 measurements, with about 1 minute in between. Write down your measurements or store them in the monitor’s memory. It’s especially helpful to monitor your blood pressure starting 2 weeks after a change, which includes starting a new medication or a new exercise plan. It’s also helpful to monitor your blood pressure in the week leading up to your next appointment.

You might notice that your blood pressure is a little different in one arm than the other.¹³ A difference of about 10 mm Hg or less is usually considered normal.

The Future of High Blood Pressure Treatments

In the future, there might be newer medications for high blood pressure that work differently than any of the medications that are available now.¹⁴ There also might be ways to use existing medications for patients with specific genes or therapies that target the production of proteins in the body. Vaccines and medical devices are also options that are being explored for high blood pressure management.

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