How to Choose the Best Blood Pressure Medication for You

High blood pressure is a key risk factor for stroke and heart disease, but it can be treated. If you’ve tried lifestyle changes and your blood pressure is still greater than 130/80 mmHg, you may need medication to lower your blood pressure.

There are many different names that blood pressure medications go by, and it can be confusing to know which medication is right for you. The answer depends on many factors, such as your age, race, and medical history.

Let’s review some common blood pressure medications, so you can talk with a healthcare professional about the best option for you.

What are the different types of blood pressure medicine?

There are many different types of blood pressure medications that work in lots of different ways. Here’s a brief list of the different classes of blood pressure medications that are available:

• Diuretics: These work by having the body get rid of excess fluid. This lowers your blood pressure as a result.

• Beta-blockers: These lower the force your heart uses to beat and also lower your heart rate. Combined, these effects lower your blood pressure.

• Angiotensin-converting enzyme (ACE) inhibitors: These lower blood pressure by preventing the formation of angiotensin II, a hormone that increases blood pressure.

• Angiotensin II receptor blockers (ARBs): These affect the same hormone that ACE inhibitors use. Instead of blocking angiotensin II from being made, they block it from attaching to its receptor in the body.

• Calcium channel blockers: These medications block calcium from narrowing your arteries. This causes your arteries to relax. 

• Alpha blockers: These medications stop your arteries from tightening. This allows your arteries to relax, bringing down your blood pressure. 

• Alpha-2 receptor agonists: These medications target your central nervous system. This allows your sympathetic nervous system to relax and causes your blood pressure to lower.

• Vasodilators: These medications directly cause your arteries to relax. This allows them to open wider, lowering your blood pressure.

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What are the most common blood pressure medications?

One study of about 5 million people taking hypertension medications looked at which ones were prescribed most often. They found that the most common blood pressure medications are:

• Lisinopril (Zestril, Qbrelis)

• Hydrochlorothiazide (Microzide)

• Losartan (Cozaar)

• Amlodipine (Norvasc)

• Diltiazem (Cardizem)

Just because these are the most common blood pressure medications, it doesn’t mean that they are the right ones for you. The best blood pressure medication for you is the one that fits your specific needs. You should speak with a healthcare professional to decide which one is right for you.

What is the most popular medication for high blood pressure?

Lisinopril is the most popular blood pressure medication in the U.S. Data shows that it continues to be the most prescribed hypertension medication. It’s also the most frequently filled blood pressure medication at pharmacies.

Blood pressure medications for younger adults

There are many different options for a first-choice medication in some younger adults with high blood pressure. They’re all effective at lowering blood pressure, but differ in the ways they work. 

ACE inhibitors

ACE inhibitors are often a first choice because they’re inexpensive and well-tolerated. A simple way to tell ACE inhibitors from other blood pressure medications is to look for names that end in “il.”

Common ACE Inhibitors include:

• Benazepril (Lotensin)

• Captopril 

• Enalapril (Vasotec)

• Lisinopril

• Quinapril (Accupril)

• Ramipril (Altace)

Dry cough, headache, and high potassium levels are possible side effects of ACE inhibitors. Angioedema is a rare, potentially life-threatening reaction that can occur as well. It can cause the lips, tongue, and throat to swell, making it difficult to breathe. 

ACE inhibitors aren’t recommended during pregnancy due to possible health complications in newborns. So, if you’re considering becoming pregnant, you’ll likely need a different option. 

ARBs

ARBs are very similar to ACE inhibitors in that they also lower blood pressure and the risk of stroke in some people. ARBs and ACE inhibitors both lower the action of angiotensin II. But they have different side effects and work in slightly different ways.

ARBs don’t typically cause dry cough as a side effect, but they may cause dizziness, headache, and high potassium. As with ACE inhibitors, ARBs shouldn’t be taken if you’re pregnant or are considering becoming pregnant.

One way to identify ARBs is that their names typically end in “an.” Common ARBs include:

• Candesartan (Atacand)

• Losartan

• Irbesartan (Avapro)

• Olmesartan (Benicar)

• Telmisartan (Micardis)

• Valsartan (Diovan)

Calcium channel blockers

Calcium channel blockers are another option for people looking to control their high blood pressure. In addition to supporting bone health, calcium is a mineral that helps the heart muscle contract. Names of these blood pressure medications often, but not always, end in “ine.”

Common calcium channel blockers include:

• Amlodipine (Norvasc, Katerzia)

• Diltiazem (Cardizem)

• Felodipine extended-release

• Isradipine

• Nicardipine

• Nifedipine (Procardia)

• Nisoldipine (Sular)

• Verapamil

Dizziness, constipation, and swelling in the arms and legs are some possible side effects of calcium channel blockers. Talk with a healthcare professional if you experience any of these. 

Beta blockers

Beta blockers are an option for younger patients who can’t take ACE inhibitors or ARBs.

Some studies show that beta blockers don’t provide the same protection against stroke risk as ACE inhibitors or ARBs. But when used in combination with other medications, they can be very effective. For the most part, names of beta blockers tend to end in “ol.” Common beta blockers include:

• Atenolol (Tenormin)

• Nebivolol

• Carvedilol (Coreg)

• Metoprolol (Lopressor)

• Nadolol (Corgard)

• Propranolol

Common side effects of beta blockers include:

• Dizziness 

• Tiredness 

• Cold hands and feet

• Sexual dysfunction

Thiazide and thiazide-like diuretics

Thiazide and thiazide-like diuretics work by increasing urination. This helps the kidneys get rid of extra fluid, sodium, and potassium in the body. They’re often called “water pills.”

Many healthcare professionals suggest taking these in the morning to prevent waking at night to pee. They begin working within a couple of hours and the effects last for about 24 hours.

There are many thiazide and thiazide-like diuretics available. They’re all effective, well-tolerated, and generally inexpensive.

Common thiazide and thiazide-like diuretics include:

• Chlorthalidone (Thalitone)

• Hydrochlorothiazide 

• Indapamide 

• Metolazone

There’s some evidence that chlorthalidone is better than hydrochlorothiazide at lowering blood pressure. But hydrochlorothiazide may be safer because it’s less likely to cause electrolyte imbalances. And it’s more commonly used. 

Blood pressure medications for Black adults

In the U.S., high blood pressure is more common in Black adults than in other populations. Black people often experience more severe high blood pressure at a younger age, and some may have a hard time getting it under control.

Thiazide diuretics and calcium channel blockers are often used as first-choice medications for Black adults with high blood pressure. Other medications are sometimes avoided due to the risk of side effects. For example, angioedema from ACE inhibitors is more common in Black people. And for this reason, ACE inhibitors aren’t often a first-choice medication for Black adults. There’s also a debate on whether these medications work as well in lowering blood pressure in Black people. 

A healthcare professional can help you figure out which medication is best for you based on your medical history and risk factors.

Blood pressure medications for older adults

The risk of having high blood pressure increases with age and is often caused by stiffening of your arteries. Thiazide diuretics, ACE inhibitors, and calcium channel blockers are usually considered first for older adults.

Studies have shown that beta blockers shouldn’t be used as a first-choice treatment for high blood pressure in people over the age of 60. The potential side effects may outweigh the benefits. So, most healthcare professionals will consider all other classes of medication for older adults first.

Blood pressure medications for people with very high blood pressure

Some people with higher blood pressure readings may need to take a combination of medications. In fact, if your blood pressure is 140/90 or greater, you’ll probably be immediately prescribed a medication that combines two drugs.

Combination blood pressure medications

Combination blood pressure medications are often available as one pill. But you may be prescribed two or more pills separately. It’s best to discuss your options with a healthcare professional to decide what’s right for you.

Common combination blood pressure medications include:

• Benicar HCT: Benicar HCT is a combination of an ARB and a thiazide diuretic.

• Diovan HCT: Diovan HCT is also a combination of an ARB and a thiazide diuretic.

• Exforge: Exforge is a combination of an ARB and a calcium channel blocker.

• Lotrel: Lotrel is a combination of a calcium channel blocker and an ACE inhibitor.

What about people with heart failure, diabetes, or a history of heart attack?

Some conditions need special consideration when choosing the best blood pressure medication. These include: 

• Diabetes 

• Kidney disease

• Heart failure

• Heart attack

ACE inhibitors and ARBs help protect the kidneys of people who have kidney disease or diabetes. And a diuretic like spironolactone (Aldactone) or a beta blocker like nebivolol may be prescribed to help control blood pressure if you have heart failure. Your medical history is important in determining the best treatment plan for you.

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Written by:

Sharon Orrange, MD, MHS

Sharon Orrange, MD, MHS, is the director of wellness and preventative care at the Ellison Institute of Technology and an associate professor of clinical medicine in the Division of General Internal Medicine at the University of Southern California's Keck School of Medicine.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Farzon A. Nahvi, MD

Dr. Nahvi is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works clinically at Concord Hospital in Concord, New Hampshire, and is a clinical assistant professor of emergency medicine at the Geisel School of Medicine at Dartmouth. Prior to this, he worked as an ER physician and clinical assistant professor of emergency medicine at the Mount Sinai Health System, NYU Langone Health, NYC Health + Hospitals/Bellevue, and the Manhattan VA. He is a graduate of Cornell University and NYU School of Medicine.

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