The following 10 antihypertensive drugs – with typical dose ranges – are those most commonly used by MyHSN clinicians in routine practice:
Ramipril (ACE inhibitor): 2.5–10 mg once daily
Losartan (ARB): 25–100 mg once daily
Amlodipine (Calcium-channel blocker): 2.5–10 mg once daily
Bendroflumethiazide: 2.5–10 mg once daily
Furosemide: 40mg once daily to 120 mg twice daily
Bisoprolol: 2.5–10 mg once daily
Doxazosin: 1 mg once daily up to 8 mg twice daily
Methyldopa: 250 mg twice daily up to 1 g three times daily
Hydralazine: 12.5 mg twice daily up to 100 mg three times daily
Aliskiren: 150–300 mg once daily
Examples: Ramipril, Enalapril, Lisinopril, Perindopril
Mechanism: Reduce angiotensin II production → vasodilation → lower BP
Key side-effects: Dry cough, hyperkalaemia
Important cautions: May worsen renal function in renovascular disease or advanced CKD
Note: Do not combine with ARBs
Examples: Losartan, Candesartan, Valsartan, Irbesartan
Mechanism: Block angiotensin II receptors → vasodilation
Key side-effects: Hyperkalaemia
Clinical note: Use if ACE-Is cause cough
Note: Do not combine with ACE-Is
Examples: Amlodipine, Nifedipine, Felodipine, Lercanidipine
Mechanism: Inhibit calcium influx into vascular smooth muscle → vasodilation
Common side-effect: Ankle oedema
Examples: Bendroflumethiazide, Indapamide, Metolazone
Mechanism: Reduce sodium (and therefore water) reabsorption in distal convoluted tubule (DCT)
Key side-effects: Hyponatraemia, hypokalaemia, dehydration
Less common: Gout, impaired glucose tolerance (can worsen diabetes)
Examples: Furosemide, Bumetanide
Mechanism: Reduce sodium (and therefore water) reabsorption in ascending limb of loop of Henle
Key side-effects: Hyponatraemia, hypokalaemia, dehydration
High-dose risks: Ototoxicity, blistering rash
Examples: Bisoprolol, Atenolol, Labetalol, Metoprolol, Propranolol
Mechanism: ↓ heart rate and myocardial contractility
Role in hypertension: Limited as monotherapy; useful in heart failure, AF, post-MI
Key side-effects: Fatigue, cold extremities, bronchospasm
Examples: Doxazosin, Terazosin, Prazosin
Mechanism: Block alpha-1 receptors → vasodilation
Additional benefit: Improves urinary flow in BPH. Hence useful in older men
Key side-effects: Postural hypotension, palpitations
Example: Methyldopa
Mechanism: Reduces sympathetic outflow from the brain
Clinical use: Often used in pregnancy
Common side-effects: Sedation, fatigue
Rare but serious: Hepatitis, drug-induced lupus (SLE), haemolytic anaemia
Example: Hydralazine
Mechanism: Direct arterial smooth-muscle relaxation
Key side-effects: Headache, reflex tachycardia, oedema
Rare: Drug-induced lupus (SLE)
Example: Aliskiren
Mechanism: Direct renin inhibition → ↓ angiotensin II formation
Common side-effects: GI upset, dizziness
Important risks: Hyperkalaemia, angioedema
| Drug class | Example | Main mechanism | Typical role | Key side-effects |
| ACE inhibitors | Ramipril | ↓ Angiotensin II | First-line (diabetes, CKD) | Cough, ↑ potassium |
| ARBs | Losartan | Angiotensin II block | Alternative to ACE-I | ↑ potassium |
| CCBs | Amlodipine | Muscle relaxation | First-line, elderly | Ankle oedema |
| Thiazide diuretics | Bendroflumethiazide | ↓ Sodium reabsorp. | Add-on therapy | Low Na+/K+ |
| Loop diuretics | Furosemide | Potent natriuresis | Fluid overload, HF | Electrolyte loss |
| Beta-blockers | Bisoprolol | ↓ HR / contractility | HF, AF, post-MI | Fatigue, cold limbs |
| Alpha-blockers | Doxazosin | $\alpha_1$ blockade | Resistant HTN, BPH | Postural hypotension |
| Central agonists | Methyldopa | ↓ Sympathetic tone | Pregnancy HTN | Sedation, fatigue |
| Direct vasodilators | Hydralazine | Direct relaxation | Resistant HTN | Headache, tachycardia |
| Renin inhibitors | Aliskiren | Direct renin inhib. | Specialist cases | Diarrhoea, ↑ potassium |
Note. There are useful NICE 4-step guidelines for treatment of high blood pressure.
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