In this article, we will describe the kinds of drugs that are used for hypertension, and what steps your doctor should take in choosing (from the incredible array of options) your optimal treatment. Finally, we will provide a reasonably complete list of all the drugs currently used in the U.S. (and in most developed countries) for the treatment of hypertension.
Historically the treatment for what was called the "hard pulse disease" consisted in reducing the quantity of blood by bloodletting or the application of leeches.[152] This was advocated by The Yellow Emperor of China, Cornelius Celsus, Galen, and Hippocrates.[152] The therapeutic approach for the treatment of hard pulse disease included changes in lifestyle (staying away from anger and sexual intercourse) and dietary program for patients (avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar).
Reduce the stress in your life. Long-term stress can lead to high blood pressure. There are small lifestyle changes you can make to both combat stress and to manage the effects of it in healthy ways. Exercise, eating a healthy diet, limiting alcohol and caffeine intake, practicing yoga, meditation, or deep breathing, meditating, praying, journaling, laughing, listening to music, spending time with family and friends, and playing with animals can all help reduce your stress and lower blood pressure. Learn about more tips for reducing stress.

Fish are a great source of lean protein. Fatty fish like mackerel and salmon are high in omega-3 fatty acids, which can lower blood pressure, reduce inflammation, and lower triglycerides. In addition to these fish sources, trout contains vitamin D. Foods rarely contain vitamin D, and this hormone-like vitamin has properties that can lower blood pressure.


A study published in the Journal of Bioscience, Biotechnology and Biochemistry looked at the effect that vinegar has on blood pressure if it is introduced to your diet. The results of the research showed that consumption of acetic acid (which is found in apple cider vinegar) caused a significant reduction in hypertension (high blood pressure). The research found that the acetic acid reduced blood pressure by lowering the renin activity. Renin is an enzyme which helps regulate blood pressure. I mix 1-2 tablespoons in a glass of warm water in the morning. I have found like I like Braggs ACV with the mother.
^ Nagele, Eva; Jeitler, Klaus; Horvath, Karl; Semlitsch, Thomas; Posch, Nicole; Herrmann, Kirsten H.; Grouven, Ulrich; Hermanns, Tatjana; Hemkens, Lars G.; Siebenhofer, Andrea (2014). "Clinical effectiveness of stress-reduction techniques in patients with hypertension". Journal of Hypertension. 32 (10): 1936–44. doi:10.1097/HJH.0000000000000298. ISSN 0263-6352. PMID 25084308.

Women who are taking ACE inhibitors or ARBs for high blood pressure should not become pregnant while on this class of drugs. If you're taking an ACE inhibitor or an ARB and think you might be pregnant, see your doctor immediately. These drugs have been shown to be dangerous to both mother and baby during pregnancy. They can cause low blood pressure, severe kidney failure, excess potassium (hyperkalemia) and even death of the newborn.
Blood pressure guidelines show the lower the blood pressure numbers the better. As long as no symptoms of trouble are present there is no one number that doctors consider being too low. The guidelines call for an individualized, risk-based approach to managing hypertension, as well as a personal consultation with a health care provider. While the new guidelines mean we are more aggressive about blood pressure control, lifestyle changes are always a part of the treatment plan. A treatment plan is agreed to by patient and provider, and includes ongoing communication to see how the patient is feeling and how their medications are working.
Often, hypertension can improve with lifestyle changes. In some cases, high blood pressure can go down to normal levels with only lifestyle modifications, particularly if you have stage 1 hypertension (systolic blood pressure of 130 mmHg to 159 mmHg, or diastolic blood pressure 80 mmHg to 99 mmHg), or if you have elevated blood pressure (systolic blood of 120 mmHg to 129 mmHg and diastolic less than 80 mmHg).
Changes in blood vessel function. The lining of blood vessels sustains more damage over time. This may be caused by oxidative stress or DNA damage, among other factors. With age, levels of the hormone angiotensin also rise, triggering inflammation in blood vessels. At the same time, vessels slowly lose the ability to release substances that protect or repair the lining. When the blood vessel lining does not work as well, higher diastolic blood pressures can result.
Hypertension is the most important preventable risk factor for premature death worldwide.[149] It increases the risk of ischemic heart disease,[150] strokes,[23] peripheral vascular disease,[151] and other cardiovascular diseases, including heart failure, aortic aneurysms, diffuse atherosclerosis, chronic kidney disease, atrial fibrillation, and pulmonary embolism.[11][23] Hypertension is also a risk factor for cognitive impairment and dementia.[23] Other complications include hypertensive retinopathy and hypertensive nephropathy.[27]
Unfortunately, this seems like a common scenario — medical guidelines recommend more aggressive medication use for minimal potential benefit despite potential harm. A new study published in the Journal of the American Medical Association (JAMA), suggests the blood pressure guidelines go too far for low risk individuals, and the risk of harm outweighs the potential benefits.
When a direct cause for high blood pressure can be identified, the condition is described as secondary hypertension. Among the known causes of secondary hypertension, kidney disease ranks highest. Hypertension can also be triggered by tumors or other abnormalities that cause the adrenal glands (small glands that sit atop the kidneys) to secrete excess amounts of the hormones that elevate blood pressure. Birth control pills -- specifically those containing estrogen -- and pregnancy can boost blood pressure, as can medications that constrict blood vessels.

You will work with your provider to come up with a treatment plan. It may include only the lifestyle changes. These changes, such as heart-healthy eating and exercise, can be very effective. But sometimes the changes do not control or lower your high blood pressure. Then you may need to take medicine. There are different types of blood pressure medicines. Some people need to take more than one type.

Do not attempt to lower extremely elevated blood pressure in yourself or someone else. While the goal is to reduce blood pressure before additional complications develop, blood pressure should be reduced over the course of hours to days, depending on severity. It is important not to lower blood pressure too quickly, because rapid blood pressure reductions can cut off the supply of blood to the brain, leading to brain damage or death.
^ Xie, X; Atkins, E; Lv, J; Bennett, A; Neal, B; Ninomiya, T; Woodward, M; MacMahon, S; Turnbull, F; Hillis, GS; Chalmers, J; Mant, J; Salam, A; Rahimi, K; Perkovic, V; Rodgers, A (30 January 2016). "Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis". Lancet. 387 (10017): 435–43. doi:10.1016/S0140-6736(15)00805-3. PMID 26559744.

Health care providers measure blood pressure with a sphygmomanometer (sfig-mo-muh-NAH-muh-ter), which has a cuff that's wrapped around the upper arm and pumped up to create pressure. When the cuff is inflated, it squeezes a large artery in the arm, stopping the blood flow for a moment. Blood pressure is measured as air is gradually let out of the cuff, which allows blood to flow through the artery again.

Serum creatinine is measured to assess for the presence of kidney disease, which can be either the cause or the result of hypertension. Serum creatinine alone may overestimate glomerular filtration rate and recent guidelines advocate the use of predictive equations such as the Modification of Diet in Renal Disease (MDRD) formula to estimate glomerular filtration rate (eGFR).[27] eGFR can also provide a baseline measurement of kidney function that can be used to monitor for side effects of certain anti-hypertensive drugs on kidney function. Additionally, testing of urine samples for protein is used as a secondary indicator of kidney disease. Electrocardiogram (EKG/ECG) testing is done to check for evidence that the heart is under strain from high blood pressure. It may also show whether there is thickening of the heart muscle (left ventricular hypertrophy) or whether the heart has experienced a prior minor disturbance such as a silent heart attack. A chest X-ray or an echocardiogram may also be performed to look for signs of heart enlargement or damage to the heart.[23]

An important part of a high blood pressure treatment plan is to stick to a healthy diet, including limiting sodium intake. The 2015-2020 Dietary Guidelines for Americans recommend consuming less than 2,300 milligrams (mg) of sodium per day (2). People with high blood pressure may need to restrict sodium intake even more. The American Heart Association (AHA) recommends an ideal limit of no more than 1,500 mg per day for adults with hypertension. (3)
^ Roerecke, Michael; Tobe, Sheldon W.; Kaczorowski, Janusz; Bacon, Simon L.; Vafaei, Afshin; Hasan, Omer S. M.; Krishnan, Rohin J.; Raifu, Amidu O.; Rehm, Jürgen (27 June 2018). "Sex‐Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta‐Analysis of Cohort Studies". Journal of the American Heart Association. 7 (13): e008202. doi:10.1161/JAHA.117.008202.
This range of BP isn’t in a dangerous reading, you’re obviously taking good care of your health, which is very nice. What concerns me is you used to have low blood pressure and now you have high blood pressure, does the change occur today and you were in low BP yesterday? In case your BP was below 120/80 yesterday and days before yesterday, then I think you need to talk to your dr. since something might occur that raised your BP. Yet if you haven’t been measuring the BP for a period of time, I would think you’ll need to start on BP medication.
^ Xie, X; Atkins, E; Lv, J; Bennett, A; Neal, B; Ninomiya, T; Woodward, M; MacMahon, S; Turnbull, F; Hillis, GS; Chalmers, J; Mant, J; Salam, A; Rahimi, K; Perkovic, V; Rodgers, A (30 January 2016). "Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis". Lancet. 387 (10017): 435–43. doi:10.1016/S0140-6736(15)00805-3. PMID 26559744.
Changes in blood vessel structure. Blood vessels have layers of the proteins elastin and collagen. Elastin is what makes blood vessels flexible. Collagen, which is stiffer, gives vessels structure. With age, elastin breaks down. Even the elastin that remains becomes less elastic. Meanwhile, collagen deposits in the vessels increase. As a result, blood vessels grow thicker and bend less easily over time. These changes may lead to higher systolic blood pressure.
The reasons for this astonishing success are not yet entirely understood. Certainly, two of the major causes of high blood pressure are being addressed: excessive dietary salt is completely eliminated, and it is likely that some patients experience some reversal of the atherosclerosis process. However, Dr. Campbell has suggested that additional mechanisms may be partly responsible for fasting’s remarkable effects, such as the rapid reduction of a phenomenon known as “insulin resistance.”
Be proactive and follow all medical advice received about how to manage hypertension. It is crucial to continue on any prescriptions given to treat hypertension. It is very dangerous to stop taking a medication for hypertension just because the symptoms seem to have lessened. Have frequent medical checkups and stay in touch with the doctor if any new symptoms arise.
This range of BP isn’t in a dangerous reading, you’re obviously taking good care of your health, which is very nice. What concerns me is you used to have low blood pressure and now you have high blood pressure, does the change occur today and you were in low BP yesterday? In case your BP was below 120/80 yesterday and days before yesterday, then I think you need to talk to your dr. since something might occur that raised your BP. Yet if you haven’t been measuring the BP for a period of time, I would think you’ll need to start on BP medication.
Some women with normal blood pressure develop high blood pressure during pregnancy. As part of your regular prenatal care, your doctor will measure your blood pressure at each visit. If you develop high blood pressure, your doctor will closely monitor you and your baby and provide special care to lower the chance of complications. With such care, most women and babies have good outcomes.
Essential hypertension is also greatly influenced by diet and lifestyle. The link between salt and high blood pressure is especially compelling. People living on the northern islands of Japan eat more salt per capita than anyone else in the world and have the highest incidence of essential hypertension. By contrast, people who add no salt to their food show virtually no traces of essential hypertension.

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Hypertension in African-Americans tends to occur earlier in life and tends to be more severe. Plus, some medications that work to lower blood pressure in other ethnicities may have limited effect on African-Americans. Thiazide diuretics (such as HCTZ) or a calcium channel blocker are recommended first choices along with the possible add-on of a second drug from either the ACE inhibitor class or the angiotensin II receptor blocker group.
Enlarged heart. High blood pressure increases the amount of work for your heart. Like any heavily exercised muscle in your body, your heart grows bigger (enlarges) to handle the extra workload. The bigger your heart is, the more it demands oxygen-rich blood but the less able it is to maintain proper blood flow. As a result, you feel weak and tired and are not able to exercise or perform physical activities. Without treatment, your heart failure will only get worse.
“I always recommend that people find something that they enjoy doing to stay in shape. For example, line dancing, walking outside, and riding a bike are all good ways to get active,” says Scott Parker, a health and fitness trainer and a national spokesperson for #GoRedGetFit — an online fitness challenge for women hosted by the AHA and Macy’s. “It’s also important to find other people you like doing the activity with, because that helps you stick with it.”
Enlarged heart. High blood pressure increases the amount of work for your heart. Like any heavily exercised muscle in your body, your heart grows bigger (enlarges) to handle the extra workload. The bigger your heart is, the more it demands oxygen-rich blood but the less able it is to maintain proper blood flow. As a result, you feel weak and tired and are not able to exercise or perform physical activities. Without treatment, your heart failure will only get worse.
Preeclampsia is a condition that affects about 5 to 8 percent of pregnant women. In the women it affects, it usually develops after 20 weeks of pregnancy. Rarely, this condition can occur earlier in pregnancy or even postpartum. The symptoms include high blood pressure, headaches, possible liver or kidney problems, and sometimes sudden weight gain and swelling. 

Why stress happens and how to manage it Stress is essential for survival; the chemicals it triggers help the body prepare to face danger and cope with difficulty. Long-term stress is linked to various health conditions and can cause physical and psychological symptoms. How is it diagnosed, what types of stress are there, and how is it treated or managed? Read now
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
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