5 Outdated High Blood Pressure Medications You Should Consider Upgrading

High blood pressure, also known as hypertension, affects nearly half of all adults in the U.S. Over time, hypertension can damage your blood vessels. And that means you’ll be more likely to have a stroke, heart attack, kidney damage, and dementia. 

Hypertension is almost always treatable. Changes in diet, exercise, and body weight can help. But when those things aren’t enough, medications are the best way to manage high blood pressure. Many medications for high blood pressure have been around for decades. But some older medications can cause serious side effects. 

Several expert organizations regularly update guidelines for treating high blood pressure based on the latest research. But not all healthcare professionals may be aware of the updated guidelines for choosing the best blood pressure medications. But you can be. In this article, we’ll review some common older blood pressure medications that may now be out of date. 

5 of the worst blood pressure medications

The following medications haven’t always been the “worst” choice for everyone. They may have been the best options at the time. In some cases, your healthcare team may have chosen a certain medication because it also treated another condition that you have. If that’s the case, it may be the right choice for you. 

If you’re taking any of these older blood pressure medications, check with your healthcare team to see if it’s time to make a change.

1. Beta blockers

Beta blockers aren’t usually a first-choice blood pressure medication. For most people, other medications can lower blood pressure more effectively with fewer side effects. 

Common beta blockers include:

• Atenolol (Tenormin)

• Metoprolol (Toprol)

• Propranolol (Inderal)

• Bisoprolol (Zebeta)

Side effects of beta blockers may include: 

• Dizziness 

• Nausea

• Low blood sugar

• Shortness of breath and wheezing

• Fatigue

• Rash

• Erectile dysfunction

• Low heart rate

• High triglycerides

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But there are certain scenarios where a beta blocker is the best choice. This might be the case if you:

• Need more than one medication to lower your blood pressure

• Have other heart conditions, like atrial fibrillation, coronary artery disease (CAD), or heart failure 

• Are pregnant

Beta blockers can be the right option for many people. But if you’re only taking one for high blood pressure, check with your healthcare team to be sure it’s the best option for you.

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2. Loop diuretics

Furosemide (Lasix) is a type of diuretic (water pill) known as a loop diuretic. Loop diuretics aren’t considered a first-choice medication for lowering blood pressure. But they’re useful for getting rid of excess fluid in your legs and lungs if you have heart failure.

Common loop diuretics include:

• Furosemide (Lasix)

• Bumetanide (Bumex)

• Torsemide (Demadex)

Side effects of loop diuretics include:

• Frequent urination

• Dizziness

• Low potassium and magnesium

• Rash

• Dehydration

• Stomach upset

• Ringing in your ears

If you’re taking a loop diuretic, you’ll need regular blood work to monitor your kidney function and electrolytes.

On the other hand, thiazide diuretics — such as chlorthalidone and hydrochlorothiazide — are good options for treating high blood pressure. We’ll cover those later in this article. 

3. Alpha blockers

Terazosin (Hytrin) and prazosin (Minipress) are alpha blockers. They can be used to lower blood pressure. But they also treat symptoms related to an enlarged prostate, like difficulty urinating. 

The biggest downside to alpha blockers is a drop in blood pressure when standing up, known as orthostatic hypotension. This can lead to fainting episodes, especially if you get up at night to go to the bathroom. This side effect is more likely to happen in the first few days after starting the medication.

Alpha blockers can also cause:

• Dizziness

• Headache

• Drowsiness

If you’re taking an alpha blocker only for high blood pressure, check with your healthcare team to see if there’s a better choice for you. 

4. Vasodilators

Hydralazine (Apresoline) is a vasodilator, a type of medication that relaxes blood vessels. Compared with other blood pressure medications, hydralazine has more side effects. So, this isn’t considered a first-choice option. 

Side effects of hydralazine can include:

• Headaches

• Dizziness

• Heart palpitations

• Stomach upset

• Diarrhea

• A condition that’s similar to lupus (usually after several months of use)

• Liver injury

In some cases, hydralazine can be added to other medications to control blood pressure. It can also be a good choice for people with heart failure, especially if they can’t take other medications for the condition. If you’re taking hydralazine, you should get regular checkups to be sure you’re not developing side effects.

5. Alpha-2 agonists

Clonidine (Catapres) belongs to a class of medications called central alpha-2 agonists. Clonidine isn’t a first-choice blood pressure medication because it has many side effects. These side effects include rebound hypertension if it’s stopped abruptly or if doses are skipped. Clonidine pills usually need to be taken at least twice daily, so this can also be a problem. There’s also a clonidine patch that you replace weekly. 

Other possible side effects of clonidine include: 

• Drowsiness 

• Dry mouth

• Slow heart rate 

• Stomach upset

• Erectile dysfunction

• Depression

If you’re taking clonidine for high blood pressure and haven’t tried other medications, talk with your healthcare professional to see if there’s a better option for you.

Best blood pressure medications

Healthcare professionals use expert guidelines as a starting point. But it’s important to remember that everyone is different. What’s best for one person may not be right for another. The right treatment can depend on things like your age, other health conditions, and how each medication behaves inside your body. 

Thiazide diuretics 

Thiazide diuretics have been around for more than 50 years. They help your kidneys remove extra water and salt from your body, which lowers blood pressure. They also relax your blood vessels.

There are two main thiazide medications: 

• Chlorthalidone is a little stronger and can last longer in your body. This means it may cause more side effects. 

• Hydrochlorothiazide is often combined with another blood pressure medication in a single pill. This can make it easier if, like many people, you need more than one medication to control your blood pressure. 

Side effects of thiazide diuretics include:

• Dehydration

• Stomach upset

• Dizziness

• Dangerously low sodium levels

• Low potassium

• Kidney problems

• High blood sugar

If you take a thiazide diuretic, you should have periodic blood tests to monitor your kidney function and electrolyte levels. 

Thiazides aren’t the best choice if you:

• Already have kidney problems 

• Are pregnant

• Have sulfa allergies

ACE Inhibitors 

ACE inhibitors are medications that block an enzyme called ACE (angiotensin-converting enzyme). ACE normally makes your blood vessels constrict. By blocking this enzyme, blood can flow more easily through your arteries.

ACE inhibitors are often used to protect the kidneys in people with diabetes. They can also be a good choice if you have congestive heart failure.

Examples of ACE inhibitors include: 

• Lisinopril (Prinvil, Zestril)

• Benazepril (Lotensin)

• Ramipril (Altace)

Potential side effects of ACE inhibitors include:

• Dry cough

• Dizziness

• Angioedema (swelling of the face, lips, or throat)

• High potassium levels in your blood

• Reduced kidney function

When it comes to the kidneys, ACE inhibitors can be a little tricky. People with poor kidney function may need to avoid ACE inhibitors. But sometimes these medications can protect the kidneys from further damage. If your kidneys don’t function normally, a kidney specialist (nephrologist) can help decide the best option for you.

ACE inhibitors have some risks and precautions to be aware of:

• They should not be combined with angiotensin II receptor blocker (ARB) medications, which are covered in the next section. 

• They shouldn’t be taken with NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen. 

• If you’re taking a diuretic (water pill), regular blood work is needed to monitor for electrolyte and kidney problems.

• If you’re pregnant, or think you might get pregnant soon, you should avoid ACE inhibitors. They can cause permanent harm to your developing fetus’ kidneys, especially in the second and third trimesters. They can also reduce the protective amniotic fluid that surrounds the fetus.

ARBs 

ARB medications block a receptor that causes your blood vessels to constrict. Since ARBs work similarly to ACE inhibitors, they’re not generally taken together.

Examples of ARBs include:

• Losartan (Cozaar)

• Valsartan (Diovan)

• Irbesartan (Avapro)

• Candesartan (Atacand)

• Azilsartan (Edarbi)

• Olmesartan (Benicar)

Unlike ACE inhibitors, ARBs don’t usually cause a cough. Otherwise, they have similar side effects. These include the effects on your kidneys.

If you’ve had angioedema with an ACE inhibitor, you might get it with an ARB as well. This reaction can be life-threatening. So, it’s important to let your healthcare team know of any previous side effects.

Like ACE inhibitors, ARB medications shouldn’t be used if you’re pregnant.

Calcium channel blockers 

Calcium channel blockers (CCBs) work by blocking calcium from entering the cells in your blood vessels. This helps relax the blood vessels and lowers your blood pressure. In normal doses, CCBs don’t affect your kidney function. They also don’t change the calcium levels in your blood or bones. That means you don’t need regular blood work while taking them. 

Examples of CCBs include

• Amlodipine (Norvasc) 

• Nifedipine (Procardia)

• Felodipine (Plendil)

• Diltiazem (Cardizem, Cartia)

• Verapamil (Calan)

Common side effects of CCBs include

• Edema (swelling of your legs and feet)

• Headaches

• Constipation

• Dizziness

In addition to lowering your blood pressure, diltiazem and verapamil can also lower your heart rate. That’s why these medications are sometimes prescribed for people who also have atrial fibrillation. But it’s important to be cautious when using verapamil or diltiazem with a beta blocker or other medications that reduce heart rate.

Certain calcium channel blockers are sometimes used for high blood pressure during pregnancy. But it’s important to have close monitoring with an obstetrician.

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Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology, the American College of Physicians, and the American Society of Echocardiography.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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