Treating high blood pressure with drugs

Some treatments may not be suitable for you, depending on your exact circumstances. If you have questions about specific treatments and options, please talk to your doctor or nurse.

Your doctor should offer you drug treatment if your blood pressure is considered to be high and any of the following apply to you.

  • You have damage to the blood vessels in your heart, brain, kidneys or eyes.

  • You have cardiovascular disease.

  • You have kidney disease.

  • You have diabetes.

  • Your likely risk of developing cardiovascular disease during the next 10 years is 20% (a one-in-five chance) or more.

  • Your clinic blood pressure is 160/100 mmHg or above and your average ambulatory or home blood pressure is 150/95 mmHg or above.

Your doctor or nurse should offer you information about how drugs can help to lower blood pressure and about their possible side effects so that you can be involved in all the decisions about your treatment.

If you are aged over 80, your doctor should offer you the same drug treatment for high blood pressure that is offered to people aged over 55. When offering you drug treatment they should take into account any other medical problems you have.

If you are a woman who is pregnant or breastfeeding, or if you may become pregnant, it is important that you tell your doctor or nurse. They should check whether the drugs you are taking to lower your blood pressure are still safe for you to take. You may be advised to switch to another type of drug. There is more information about this in 'Hypertension in pregnancy' (available from www.nice.org.uk/guidance/CG107).

Most people will need more than one type of drug to lower their blood pressure. Whenever possible, your doctor should offer you drugs that only need to be taken once a day.

Your doctor or nurse should offer you practical advice and support to make sure you get the most benefit from your drugs, for example by:

  • making a note when you take your drugs

  • using a box with different compartments to help you remember whether you've taken your drugs

  • having special packaging that you can open more easily

  • fitting your drugs into your daily routine.

Blood pressure targets

The aim of treatment is to get your clinic blood pressure down to below 140/90 mmHg if you are aged under 80, or below 150/90 mmHg if you are aged 80 or over.

If your blood pressure is generally higher than usual for you when it is measured at the GP practice or clinic, your doctor may offer you ambulatory or home blood pressure monitoring to check how well your drug treatment is working (see Blood pressure monitoring). The aim is to get your average ambulatory or home blood pressure down to below 135/85 mmHg if you are aged under 80, or below 145/85 mmHg if you are aged 80 or over.

If the first drug you take doesn't work well enough, your doctor may offer to add a second drug of a different type. If these two drugs together don't work, your doctor may offer to add a third type of drug. And if three types of drug taken together don't work, your doctor may offer to add a fourth.

If your blood pressure is still high after taking four drugs, your doctor should refer you to a specialist.

Once your blood pressure has come down to below 140/90 mmHg, or below 150/90 mmHg if you are aged 80 or over, you should be offered a yearly check-up. At this check-up the doctor or nurse should measure your blood pressure and offer you further support and advice. The check-up also gives you a chance to ask questions about your treatment and discuss any symptoms or side effects you may have noticed.

Some of the drugs that are used to treat high blood pressure are shown in Some drugs used to treat high blood pressure.

Questions you might like to ask your doctor or nurse about drugs for high blood pressure

  • Could you tell me why you have decided to offer me this drug?

  • How will this drug help me?

  • What are the most common side effects of this drug?

  • What should I do if I get any side effects? For example, should I call you, or go to the emergency department at a hospital?

  • How long will I need to take the drug for?

  • Are there any long-term effects of taking this drug?

  • Are there any other options for treatment?

  • What will happen if I choose not to take the drug?

  • Is there a leaflet or other information that I can have?

Some drugs used to treat high blood pressure

Type of drug

Who does it work best for?

ACE inhibitor (for example, enalapril, lisinopril, perindopril, ramipril)

An ACE inhibitor is often the first drug offered to treat high blood pressure.

  • People aged under 55 years

  • People of any age who are not of black African or Caribbean family origin (ACE inhibitors do not work as well in these groups of people.)

Angiotensin II receptor blocker, sometimes known as an ARB (for example, candesartan, irbesartan, losartan,valsartan)

An ARB is sometimes the first drug offered to treat high blood pressure.

  • People who are not able to take ACE inhibitors because of side effects such as a dry cough

Calcium-channel blocker (for example, amlodipine, felodipine, nifedipine)

  • People who are aged over 55 years

  • Black people of any age who are of African or Caribbean family origin

Diuretic (for example, chlortalidone, indapamide, bendroflumethiazide)

  • People who need three or four drugs to lower their blood pressure

  • People who cannot take a calcium-channel blocker because they have swelling caused by fluid retention or have a high risk of heart problems

Alpha-blocker (for example, doxazosin, prazosin) or beta-blocker (for example,atenolol, bisoprolol)

Alpha-blockers and beta-blockers are used less commonly than other drugs for high blood pressure.

  • People who need four drugs to lower their blood pressure and who cannot take some other drugs

  • For some people a beta-blocker may be the first drug offered to lower their blood pressure

  • Information Standard