What are the 10 most common blood pressure (BP) tablets?
- Ramipril – dose 2.5-10mg OD
- Losartan – 25-100mg OD
- Amlodipine – 2.5-10mg OD
- Bendroflumethazide (BFZ) – 2.5-10mg OD
- Furosemide – 20mg- 250mg OD (or 120 mg BD)
- Bisoprolol – 2.5-10mg OD
- Doxazosin – 1mg OD – 8mg BD
- Methyldopa – 250mg BD – 1g TDS
- Hydralazine – 12.5mg BD – 100mg TDS
- Aliskerin – 150-300mg OD.
These are the drugs (and dose ranges) favoured by MyHSN.
We will now go through these 10 most common blood pressure tablets (and the groups they are from) in more detail.
1. ACE inhibitors (ACEs)
ACE (Angiotensin-converting enzyme) inhibitors help to control hormones that play a role in blood pressure control.
- Names: End in ‘pril’; for example, Enalapril, Fosinopril, Lisinopril, Perindopri, Ramipril (2.5-10mg OD)
- Mechanism: cause the blood vessels to relax and widen (called vasodilatation). This allows more blood to pass through, lowering blood pressure
- Side-effects: cough, hyperkalaemia
- Less common side-effects: can worsen kidney function (or cause AKI) in at risk CKD patients, e.g. with renovascular disease.
2. Angiotensin receptor blockers (ARBs)
These work in a similar way to ACE inhibitors; controlling the hormones that affect blood pressure.
They are mainly usually used if ACE inhibitors are causing side effects (e.g. cough).
- Mechanism: cause the blood vessels to relax and widen, which lowers blood pressure
- Names: End in ‘sartan’; for example, Candesartan, Irbesartan, Valsartan, Olmesartan, Losartan (25-100mg OD)
- Side-effects: hyperkalaemia
- Less common side-effects: can worsen kidney function (or cause AKI) in at risk CKD patients (e.g. with renovascular disease).
Note. You should not take an ACE inhibitor and ARB at the same time.
Mechanism of action
3. Calcium-channel blockers (CCBs)
- Names: Most end in ‘pine’ (pronounced, peen) – for example, Lercanidipine, Felodipine, Nifedipine, and Amlodipine (2.5-10mg OD). Diltiazem is another CCB
- Mechanism: cause the blood vessels to relax and widen (called vasodilatation), which lowers blood pressure
- Common side-effects: leg oedema (swelling).
4. Thiazide diuretics
These are sometimes known as ‘water tablets’ because they remove excess fluid from the body, including from the blood. This means there is less pressure on the blood vessel walls.
- Names: Most end in ‘ide’, for example, Indapamide, Hydrochlorothiazide, Bendroflumethiazide (2.5-10mg OD)
- Mechanism: prevent sodium (and therefore water) reabsorption in the renal tubules, leading to increased urination
- Side effects: low sodium and potassium, and high calcium levels, dehydration
- Less common side-effects: diabetes (or worsening of), gout.
Metolazone is another thiazide diuretic. It is is often used for intractable fluid overload in combination with a loop diuretic (at high dosage).
5. Loop diuretics
Another type of water tablet.
- Names: e.g. Bumetanide and Furosemide (20-250mg OD (or 120mg BD)) (40 mg OD of Furosemide is equivalent to 1mg OD of Bumetanide)
- Mechanism: prevent sodium (and therefore water) reabsorption in the renal tubules, leading to increased urination
- Side effects: low sodium, potassium, and calcium levels, dehydration
- Less common side-effects: pancreatitis, gout; (in high dosage) blistering rash, deafness.
6. Beta blockers
Beta-blockers are now rarely used for blood pressure treatment alone.
This is because they have been found to be less effective in preventing strokes and heart attacks than other medication choices.
However, sometimes they may be used where there are other conditions present, such as heart failure or atrial fibrillation (AF).
- Names: End in ‘olol’; for example, Propranolol, Metoprolol, Atenolol, Labetalol (used alot in pregnancy), Nebivolol, Carvedilol, Bisoprolol (2.5-10mg OD)
- Mechanism:
- Block beta-1 receptors in the heart, which slows the heart rate and reduces the force of contraction
- Block beta-2 receptors in the lungs, liver, and other tissues, which can cause blood vessels to constrict (and constrict bronchi)
- Side-effects: Fatigue, Dizziness or lightheadedness, Cold hands and feet
- Less common side-effects: Insomnia or vivid dreams, Sexual dysfunction (rare), Masking of hypoglycaemia symptoms in people with diabetes, Raynaud’s phenomenon (cold hands and feet), Increased risk of asthma attacks in people with asthma.
7. Alpha blockers
- Names: Most end in ‘sin’; for example, Prazosin, Terazosin, Alfuzosin, Tamsulosin (also used for prostatism), Indoramin, Doxazosin (1mg OD – 8mg BD)
- Mechanism: Alpha blockers work by selectively blocking alpha-1 adrenergic receptors in the smooth muscle of blood vessels and the prostate gland. This leads to:
- Relaxation of smooth muscle in blood vessels, causing vasodilation and decreased blood pressure
- Relaxation of smooth muscle in the prostate gland, improving urine flow and relieving symptoms of benign prostatic hyperplasia (BPH)
- Side-effects: Orthostatic hypotension (dizziness or lightheadedness when standing up), Headache, Nausea/Diarrhoea, Ejaculation problems (in men)
- Less common side-effects: Hypotension (low blood pressure), Tachycardia (rapid heart rate), Palpitations, Oedema (swelling), Pruritus (itching), Urticaria (hives), Hepatitis/Jaundice.
8. Centrally acting antihypertensive drug (central alpha-2 agonist) – e.g. methyldopa (25omg BD – 1g TDS)
- Mechanism. Methyldopa works by stimulating alpha-2 adrenergic receptors in the brain, which decreases the sympathetic nervous system activity. This leads to:
- Decreased peripheral resistance
- Decreased heart rate
- Decreased blood pressure
- Side-effects: Drowsiness, Fatigue, Headache, Dizziness
- Less common side-effects: Haemolytic anaemia (rare), Hepatitis/Jaundice, Myocarditis/Pericarditis, Lupus-like syndrome, Psychotic reactions (rare), Seizures (rare).
Note. Clonidine and moxonidine (100-400 mcg a day, in 1-2 doses) are other centrally acting BP agents.
9. Other vasodilators – e.g. hydralazine (12.5mg BD – 100mg TDS)
- Mechanism. Hydralazine is a direct vasodilator that works by relaxing the smooth muscles in blood vessel walls. This causes the blood vessels to relax and widen (called vasodilatation), which lowers blood pressure
- Side effects: headache, dizziness or lightheadedness, nausea and vomiting, flushing or redness of the skin, rapid heartbeat (tachycardia), swelling of the ankles or feet
- Less common side Effects: Lupus-like syndrome (a rare autoimmune disorder), fever, joint pain or arthritis, muscle weakness, skin rash or itching, blood disorders (such as anaemia or low white blood cell count).
Note. Minoxidil is another very strong vasodilator, and should only be prescribed by hospital specialists. The dose range is 5-100 mg, given daily as a single dose or in 2 or 3 divided doses. But as it is a very strong drug, it is often started cautiously at 2.5 mg 2-3x a week.
10. Renin inhibitors (a newish group of drugs) – e.g. aliskerin (150-300 mg OD)
- Mechanism. Aliskiren is a direct renin inhibitor that works by blocking the action of renin, an enzyme involved in the production of angiotensin I. This leads to a decrease in the production of angiotensin II, a potent vasoconstrictor, resulting in vasodilation and a subsequent reduction in blood pressure.
- Side effects: diarrhoea, nausea, vomiting, cough, headache, dizziness, , muscle spasms, flu-like symptoms
- Less common side effects: angioedema (a rare but potentially life-threatening condition characterised by rapid swelling of the skin and mucous membranes), abnormal liver function tests, increased uric acid levels, increased potassium levels (hyperkalaemia), allergic reactions (such as skin rash or itching), blood disorders, such as anaemia or low white blood cell count.
What about side-effects?
All medicines have possible side-effects, and no medicine is without risk.
However, most people who take medicines to lower blood pressure do not develop any side-effects, or only have mild side-effects.
A full list of cautions and possible side-effects is listed on the leaflet inside the medicine packet. Some side-effects are described above.
Summary
We have described what are the 10 most common blood pressure tablets. We hope you understand them better now.
Other resources
What causes high blood pressure?
10 most commonly prescribed drugs in England, France and USA
This a good review article. It especially explains what is useful in different groups, e.g. in elderly and pregnancy.
