6 Outdated High Blood Pressure Medications You Should Consider Upgrading

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Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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If you’ve been able to control your high blood pressure with the same hypertension medications for years, it’s tempting to hold the course — but don’t. Older medications can cause serious side effects, and updated guidelines for treating high blood pressure are released every year with recommendations for current best therapies.

It’s natural for newer medications that work better and pose fewer risks to replace older ones. If you’re taking any of the following six outdated medications, it’s worth discussing with your doctor about a potential upgrade.

Atenolol

Except in cases of coronary artery disease (CAD) and heart failure, beta-blockers like atenolol are not used as first-line therapies to lower blood pressure. Even in these special cases, newer beta-blockers like bisoprolol (Zebeta), carvedilol (Coreg), and nebivolol (Bystolic) are preferred.

In general, atenolol doesn’t protect the heart as well as first-line blood pressure medications like ACE inhibitors and certain diuretics. (You can read more about these medications in my previous article here: Choosing Your Blood Pressure Medication.) Atenolol may also cause negative effects on blood sugar and cholesterol, which can increase your risk for diabetes and hyperlipidemia (or high levels of fat in the blood).

Furosemide (Lasix)

Like atenolol, furosemide (Lasix) is not a first-choice medication when it comes to lowering blood pressure, although the diuretic is useful for leg swelling as a result of heart failure. Instead, chlorthalidone is our currently preferred diuretic medication because it’s been proven to reduce heart disease risk and stays active for a long time. Hydrochlorothiazide (HCTZ) is another good diuretic choice, but again, chlorthalidone is preferred.

Nifedipine (Adalat, Procardia)

Nifedipine (Adalat, Procardia) belongs to a class of drugs called calcium channel blockers, which lower blood pressure by relaxing the muscles of the heart and blood vessels. It was one of the most widely used medications to treat high blood pressure, but has since fallen out of favor because of concerns about safety and the fact that newer blood pressure medications with fewer risks have been developed. There are better options now.

Terazosin (Hytrin) and Prazosin (Minipress)

Terazosin (Hytrin) and prazosin (Minipress) are alpha-blocker medications that cause blood vessels to relax and dilate. They’re old-school drugs that were used to treat high blood pressure along with symptoms related to enlarged prostate (like difficulty urinating). If you’re only taking these medications for high blood pressure, make a change. They’re associated with low blood pressure when standing (aka orthostatic hypotension), which can result in fainting episodes.

Hydralazine (Apresoline)

Hydralazine (Apresoline) is known as a “direct-acting vasodilator”, which means it acts directly on blood vessels to relax and dilate them. Because hydralazine also causes salt and fluids to accumulate in blood vessels, it has to be used with a diuretic and beta-blocker to counteract the increased volume. There are very specific cases when hydralazine should be used, but not as a first- or even second-line treatment to lower blood pressure.

Clonidine (Catapres)

Unless you’ve tried several other medications and your doctor needs a last resort, stay away from clonidine (Catapres). Possible side effects include drowsiness, dry mouth, and slowed heart rate. Discontinuing clonidine treatment may result in rebound hypertension, which can make your blood pressure become dangerously high. For this reason, do not stop taking clonidine abruptly.

Time to upgrade…

Dr O.

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