5 Outdated High Blood Pressure Medications - GoodRx (2024)

High blood pressure — also known as hypertension — affects nearly half of all adults in the United States. It happens when the blood flows through your blood vessels (arteries) more forcefully than normal. This is often because the arteries are too tight or too stiff. Over time, hypertension can damage your blood vessels. And that means you’ll be more likely to have a stroke, heart attack, kidney damage, or dementia.

Hypertension is almost always treatable. Changes in diet, exercise, and body weight can help. And sometimes treating medical conditions that cause hypertension will bring your blood pressure down. But when those things don’t work, 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 national and international organizations regularly create guidelines for treating high blood pressure based on the latest research. That means that every few years, there may be updates. These help your healthcare professional treat your high blood pressure more safely and effectively.

In this article, we’ll go over some commonly used older medications that may now be out of date.

5 of the worst blood pressure medications

The following medications may not have always been the “worst” medications for everyone. They may have been started because they were the best options at the time — and that may no longer be the case. Other times, your healthcare professional will choose a certain medication because it also treats another condition that you have. In that case, it may be the right choice for you. If you’re taking any of these older blood pressure medications, check with your healthcare professional to find out whether it’s time to make a change.

1. Beta blockers

Usually, beta blockers aren’t used as first-choice therapies to lower blood pressure. For most people, other blood pressure medications can do a better job of lowering blood pressure with fewer side effects.

Common beta blockers include:

• Tenormin (Atenolol)

• 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

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• Erectile dysfunction

• Low heart rate

• High triglycerides

But there are certain scenarios where a beta blocker is the best choice:

• A beta blocker might be added to another medication if your blood pressure isn’t controlled on a single medication.

• If you have heart rhythm problems like atrial fibrillation, you might benefit from a beta blocker.

• If you have coronary artery disease (CAD) or heart failure, beta blockers may help to protect your heart.

• If you’re pregnant, certain beta blockers may be the best choice.

So taking a beta blocker can be the right thing for many people. But if you’re only taking a beta blocker for high blood pressure, check in with your healthcare professional to be sure it’s the best option for you.

2. Loop diuretics

Furosemide (Lasix) is a type of diuretic (water pill) known as a loop diuretic. Loop diuretics are not considered first-choice medication for lowering blood pressure. But, they’re useful for getting rid of excess fluid in the 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 the ears

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

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

3. Alpha blockers

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

The most important downside to alpha blockers is low blood pressure when standing. This is known as orthostatic hypotension. That can result in fainting episodes, especially if you get up to go to the bathroom in the middle of the night. 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 for high blood pressure only, check in with your healthcare professional to find out if there’s a better choice for you.

4. Vasodilators

Hydralazine (Apresoline) is in a class of medications known as arteriolar vasodilators. Compared with other medications used to treat high blood pressure, hydralazine has more side effects and 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. And it can be a good choice for people with heart failure, especially if they can’t take other medications for the condition. But 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) is in a class of medications called central alpha-2 agonists. Clonidine isn’t a first-choice medication because it has many side effects. That includes rebound hypertension if it’s stopped abruptly or if you skip doses. Clonidine pills usually have 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

Now that we’ve gone over some of the riskier medications for high blood pressure, we’ll talk about some better first-line options. It’s important to know that everyone is different. And sometimes what’s best for one person may not be right for another.

Healthcare professionals use guidelines as a starting point. The most recent guidelines for high blood pressure from the American College of Cardiology and the American Heart Association were published in 2017. In 2020, the International Society of Hypertension published their guidelines. And in 2023, the European Society of Hypertension reported their own set of guidelines. All three groups give similar guidance for the top four best choices of medications.

In this section we’ll tell you about these four classes of medications. It’s important to remember that the best blood pressure medication for you will depend on your other health conditions. And in some cases, none of these four options will be right for you.

Thiazide diuretics

Thiazide diuretics have been around for more than 50 years. They help your kidneys remove extra water and salt from the 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. That means it may cause more side effects.

• Hydrochlorothiazide is often combined into the same pill as another blood pressure medication. 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 work to monitor your kidney function and electrolytes. Your healthcare professional will order that for you, and decide how often it’s needed.

There are some situations where thiazides shouldn’t be used:

• If you already have kidney problems

• If you’re pregnant

• If you have sulfa allergies

ACE Inhibitors

ACE inhibitors are medications that block an enzyme that makes your blood vessels constrict. ACE stands for angiotensin-converting enzyme. By blocking this enzyme, blood can flow more easily through your arteries. ACE inhibitors are often used to protect the kidneys for people with diabetes. And they can 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, and throat)

• High potassium levels in the 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 shouldn’t be combined with angiotensin-2 receptor blocker (ARB) medications, which we discuss in the next section. They also shouldn’t be combined with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. And it’s important to be cautious with ACE inhibitors if you’re taking a diuretic (water pill). If you’re taking any of these medications, be sure to let your healthcare professional know. That way you can get regular blood work to be sure that your kidneys and electrolyte levels are in range.

Finally, if you’re pregnant, or think you might get pregnant soon, you should avoid ACE inhibitors. They can cause permanent harm to the developing fetus’ kidneys. The risk is especially high in the second and third trimester. They can also reduce the protective amniotic fluid that surrounds the fetus.

ARBs

ARB stands for angiotensin-2 receptor blocker. ARB medications block a receptor that causes your blood vessels to constrict. By blocking this receptor, the blood pressure will usually decrease. Since ARBs are similar 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 to ACE inhibitors. That includes the effects on the kidneys.

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

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

Calcium channel blockers

Calcium channel blockers (CCB) work by blocking calcium from entering the cells in your blood vessels. This lowers your blood pressure by relaxing the blood vessels. In normal doses, CCBs don’t affect your kidney function. They also don’t change the calcium levels in your blood or your bones. That means you don’t need regular blood work with these medications.

Examples of CCB include

• Amlodipine (Norvasc)

• Nifedipine (Procardia)

• Felodipine (Plendil)

• Diltiazem (Cardizem, Cartia)

• Verapamil (Calan)

Common side effects of CCB include

• Edema (swelling of the legs and feet)

• Headaches

• Constipation

• Dizziness

Diltiazem and verapamil can also lower your heart rate. That’s why these medications are sometimes prescribed for atrial fibrillation. It’s important to be cautious when using verapamil or diltiazem with a beta blocker or another medicine that reduces heart rate.

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