What are the medications for hypertension (high blood pressure)?

From the Guidelines

The most effective medications for hypertension include ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics, which are recommended as first-line treatments to lower blood pressure and reduce cardiovascular disease events. These medications have been shown to be effective in reducing blood pressure and cardiovascular disease events, as demonstrated in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. The recommended first-line treatments include:

• ACE inhibitors, such as lisinopril 10-40mg daily
• ARBs, such as losartan 25-100mg daily
• Dihydropyridine CCBs, such as amlodipine 5-10mg daily
• Diuretics, such as thiazide diuretics (like hydrochlorothiazide 12.5-25mg daily) Treatment usually begins with a single medication at a low dose, which may be increased or combined with other medications if blood pressure goals aren't met. Beta-blockers, such as metoprolol 25-100mg twice daily, are sometimes used, particularly in patients with certain heart conditions, as recommended in the 2024 cardiovascular disease and risk management standards of care in diabetes 1. Medication choice depends on factors including age, race, comorbidities, and potential side effects. For example, ACE inhibitors are particularly beneficial for patients with diabetes or heart failure but should be avoided in pregnancy. Lifestyle modifications are also essential alongside medication, including reducing sodium intake, maintaining a healthy weight, regular exercise, limiting alcohol, and quitting smoking. Blood pressure should be monitored regularly, and medications may need adjustment over time. These medications work by various mechanisms—diuretics reduce blood volume, ACE inhibitors and ARBs relax blood vessels by affecting the renin-angiotensin system, calcium channel blockers prevent calcium from entering heart and blood vessel cells, and beta-blockers reduce heart rate and output. In patients receiving combination BP-lowering treatment, fixed-dose single-pill combination treatment is recommended, and if BP is not controlled with a two-drug combination, increasing to a three-drug combination is recommended, usually a RAS blocker with a dihydropyridine CCB and a thiazide/thiazide-like diuretic, and preferably in a single-pill combination 1.

From the FDA Drug Label

INDICATIONS & USAGE 1. 1 Hypertension Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. What is amlodipine besylate? Amlodipine besylate is a type of medicine known as a calcium channel blocker (CCB). It is used to treat high blood pressure (hypertension) and a type of chest pain called angina.

The medications for hypertension (high blood pressure) are:

• Lisinopril 2
• Amlodipine besylate 3 These medications can be used alone or in combination with other antihypertensive agents to treat high blood pressure.

From the Research

Medications for Hypertension

The following medications are used to treat hypertension:

• Thiazide diuretics, such as hydrochlorothiazide or chlorthalidone 4
• Calcium channel blockers, such as amlodipine 5, 4, 6
• Angiotensin-converting enzyme inhibitors (ACEIs), such as enalapril or lisinopril 5, 4, 7, 8
• Angiotensin receptor blockers (ARBs), such as candesartan or losartan 5, 4, 6, 7
• Beta blockers, such as bisoprolol or metoprolol 7, 8
• Mineralocorticoid receptor antagonists, such as spironolactone 7
• Vasopeptidase inhibitors, such as omapatrilat 8
• Endothelin-1 antagonists, such as bosentan 8

Combination Therapy

Combination therapy is often used to treat hypertension, and may include:

• A thiazide diuretic and a calcium channel blocker 5, 4
• An ACEI and a calcium channel blocker 5, 4
• An ARB and a calcium channel blocker 5, 4
• A beta blocker and an ACEI or ARB 5, 7

Specific Patient Populations

Certain patient populations may require specific medications or combination therapies, such as:

• Black patients: at least one agent should be a thiazide diuretic or a calcium channel blocker 5
• Patients with heart failure: initial treatment with a beta blocker and an ACEI or ARB, followed by add-on therapy with a mineralocorticoid receptor antagonist and a diuretic 5
• Patients with chronic kidney disease and proteinuria: treatment should include an ACEI or ARB plus a thiazide diuretic or a calcium channel blocker 5
• Patients with diabetes mellitus: treatment should be similar to those without diabetes, unless proteinuria is present, in which case combination therapy should include an ACEI or ARB 5