Managing High Blood Pressure: A Break Down

Gina Maeda, Pharm.D.

Many factors can lead to high blood pressure – stress, a poor diet, smoking, or simply getting older. Lowering your blood pressure involves many of the recommendations on how to live a healthier life in general – regularly exercising, eating less salt, drinking less alcohol, and learning to manage stress. Unfortunately, these lifestyle changes do not always successfully control blood pressure levels for everyone. That is when medication is added to help.

What is a normal blood pressure?

Blood pressure is measured by two numbers: the systolic (“top number”) and the diastolic (“bottom number”) pressures. The systolic measurement is of the body’s blood vessels when they are full of blood, while the diastolic measurement is of the body’s blood vessels when they are empty (at rest). The national average blood pressure is 120/80, and a high blood pressure is usually considered 140/90 or higher.

Why should I be worried about blood pressure?

High blood pressure, or hypertension, has been called the “silent killer” because most people cannot tell when their blood pressure is elevated until it is too late.  If left untreated, hypertension can lead to very serious complications, including heart attack, stroke and kidney damage.

What kinds of medication are used to lower blood pressure?

There are a mind-boggling number of medications on the market for blood pressure.  Simply trying to pronounce some of them can be frustrating. The following table groups together some of the most common medications by how they work. There are a few combination medications that have not been included.

Type of Medication

Generic Name (Brand Name)

How It Works

Diuretics (“water pill”) Amiloride (Midamor)Bumetanide (Bumex)Chlorothiazide (Diuril)Chlorthalidone (Hygroton)Furosemide (Lasix)

Hydrochlorothiazide (HCTZ) (Esidrix, Hydrodiuril)

Indapamide (Lozol)

Spironolactone (Aldactone)

Causes the body to excrete more sodium (salt) and water in urine, which lowers how hard the heart has to work to pump blood to the rest of the body.
ACE-Inhibitors Benazepril (Lotensin)Captopril (Capoten)Enalapril (Vasotec)Fosinopril (Monopril)Lisinopril (Prinivil or Zestril)

Moexipril (Univasc)

Perindopril (Aceon)

Quinapril (Accupril)

Ramipril (Altace)

Trandolapril (Mavik)

Blocks the enzyme called ACE, which in turn lowers the amount of angiotensin II (chemical that increases blood pressure) in the body. It also expands blood vessels and makes it easier for blood to flow through.
ARBs Candesartan (Atacand)Eprosartan (Teveten)Irbesartan (Avapro)Losartan (Cozaar)Telmisartan (Micardis)

Valsartan (Diovan)

Stops the chemical angiotensin II from acting on its receptors in blood vessels; however, it does not affect the amount of the chemical in the body.
Calcium Channel Blockers (CCB) Amlodipine (Norvasc)Bepridil (Vascor)Diltiazem (Cardizem or Tiazac)Felodipine (Plendil)Nifedipine (Adalat or Procardia)

Nimodipine (Nimotop)

Nisoldipine (Sular)

Verapamil (Calan, Isoptin or Verelan)

Decreases the force with which the heart pumps, as well as relaxes blood vessels.
Beta Blockers (BB) Acebutolol (Sectral)Atenolol (Tenormin)Betaxolol (Kerlone)Bisoprolol (Zebeta)Carteolol (Cartrol)

Carvedilol (Coreg)

Metoprolol (Lopressor)

Nadolol (Corgard)

Propranolol (Inderal)

Sotalol (Betapace)

Timolol (Blocadren)

Decreases heart rate (pulse) and cardiac output (how much blood gets pumped out of the heart).


What are the side effects?

In general, medications that lower blood pressure will cause at least some dizziness at first, especially when the body shifts from sitting or lying down to standing up. Once the body adjusts to a lower blood pressure, the dizziness should lessen. Keep in mind that not everyone will experience side effects. Many people are able to take these medications without having any problems. However, it is important to know which side effects are usual and what could be problematic. This list of side effects is generalized; for more specifics, ask your local pharmacist.

  • Diuretics (“water pills”) – the urge to urinate more frequently will be most common for the first few days, but should lessen over time. Some diuretics can alter the balance of electrolytes (like potassium) in the body. Your physician may need to do lab tests to monitor levels.
  • ACE-Inhibitors and ARBs – these two classes are related and share some common side effects, like a dry cough. However, ARBs carry less of a risk for dry cough.
  • Calcium channel blockers – peripheral edema (swelling of extremities) and flushing (redness and warmth in the face, like blushing) are most common. Verapamil has the unusual side effect of gingival hyperplasia (thickening of gums).
  • Beta blockers – bradycardia (slow pulse) and edema (water retention) are most common.


Want to know more?

The American Heart Association ( is a national organization dedicated to spreading knowledge about various heart diseases, including high blood pressure. Their website is full of information and useful charts and tips. Another way to find out more is to talk to your local pharmacist. Many people do not realize that pharmacists are one of the most accessible health professionals in the community. They can tell you more about your medications, their side effects and interactions, and how to live a healthier life.

Dr. Gina Maeda was born and raised in Pearl City, Hawaii. After graduating from Pearl City High School, she completed her undergraduate and graduate studies at the University of the Pacific in Stockton, California.  She now works as a pharmacist for Kaiser Permanente in Honolulu, Hawaii.

The material presented on this site is for informational purposes only and does not necessarily represent the opinions of Keiro Senior HealthCare, The Institute for Healthy Aging at Keiro, or its contributors. Readers should consult appropriate health, legal, or financial professionals on any matter relating to their health and well-being.  Full disclaimer


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