Confirm that blood pressure is uncontrolled — There are essentially four, potentially overlapping, explanations for uncontrolled blood pressure in patients who have initiated antihypertensive therapy either with monotherapy or initial combination therapy :.

Before escalating antihypertensive drug therapy, it is generally prudent to confirm that the patient is adherent and that the blood pressure is truly above goal either with out-of-office blood pressure measurements or a series of properly performed office-based measurements [ 3 ].

See 'Assess medication adherence' below and 'Assure proper blood pressure measurement' below. If blood pressure is only slightly above goal, it may be appropriate to reassess after two to three months rather than immediately intensifying drug therapy. However, if the mild elevation persists, therapeutic inertia should be avoided, and therapy should be intensified.

Assess medication adherence — If goal blood pressure is not attained with initial therapy, adherence should be assessed. Nonadherence to medication is a common contributor to why an individual's blood pressure remains uncontrolled despite prescription of antihypertensive drug therapy.

In one meta-analysis, for example, 45 percent of all patients with hypertension were partially or completely nonadherent to antihypertensive therapy; the prevalence of partial or complete nonadherence was 84 percent among those with uncontrolled blood pressure [ 97 ].

Another meta-analysis concluded that approximately 30 percent of patients with apparent treatment resistance were nonadherent, but there was a high degree of heterogeneity, with nonadherence rates of 3 percent to 86 percent, depending upon the individual study [ 98 ].

In general, those studies that relied upon self-report found lower rates of nonadherence, whereas analyses that used more objective measures reported higher rates. Reports from other surveys indicate that at least 20 percent of patients never initiate newly prescribed antihypertensive drug therapy [ 99 ], and as many as 50 percent who actually do initiate antihypertensive medications stop taking them within one year [ ].

There are various methods for assessing adherence, each of which has significant limitations [ ]: direct patient queries, structured questionnaires, pill counts, electronic surveillance of prescription refill data, direct observation of pill taking, electronic monitoring systems, measurement of drug effects eg, activity of angiotensin-converting enzyme [ACE] in serum , and direct measurement of drug levels in either blood or urine.

These methods are discussed elsewhere. See "Patient adherence and the treatment of hypertension", section on 'Assessment of adherence'.

Our strategies to prevent nonadherence may also be helpful in addressing it once identified [ ]:. These and other strategies are presented in detail elsewhere. See "Patient adherence and the treatment of hypertension", section on 'Methods to improve adherence'.

Assure proper blood pressure measurement — Accurate measurement of blood pressure is imperative for making sound therapeutic decisions regarding antihypertensive drug therapy. However, in most clinical settings, blood pressure is not measured accurately. Before intensifying antihypertensive therapy in patients with uncontrolled blood pressure based upon casual office readings despite adherence to prescribed treatment, one or more of the following methods should be used to confirm poor control see "Blood pressure measurement in the diagnosis and management of hypertension in adults" :.

See "Blood pressure measurement in the diagnosis and management of hypertension in adults", section on 'Routine office-based blood pressure'. The device is activated by a care provider, who can continue their work and even leave the room.

AOBPM requires specialized equipment but saves time and minimally interrupts clinic flow. Like with standardized office blood pressure just mentioned, talking during the measurements should be avoided.

See "Blood pressure measurement in the diagnosis and management of hypertension in adults", section on 'Automated office blood pressure measurement'. Typically, multiple readings are obtained daily over several consecutive days, and then these readings are averaged to guide clinical decision making.

A common scenario is to instruct patients to take two to four readings daily for five to seven days before attending the clinic. See "Out-of-office blood pressure measurement: Ambulatory and self-measured blood pressure monitoring", section on 'Performance and interpretation of self-measured blood pressure SMBP '.

See "Out-of-office blood pressure measurement: Ambulatory and self-measured blood pressure monitoring", section on 'Performance and interpretation of ambulatory blood pressure monitoring ABPM '.

In most outpatient clinical settings, blood pressure is regularly measured incorrectly ie, casually measured blood pressure, without proper technique. The primary reason for the ubiquitous use of incorrect measurement technique is that of convenience.

Specifically, casual blood pressure measurement is simple, quick, and avoids workflow disruptions and interruptions.

However, casual blood pressure measurement on average produces an overestimate of the patient's blood pressure, leading to overestimates of hypertension severity and overmedication.

Uncontrolled on monotherapy. Sequential monotherapy versus adding a second drug — Among patients who do not attain goal blood pressure despite adherence to at least moderate-dose monotherapy, the options include:. In patients started on a single drug, our approach is to add a second drug rather than attempting sequential monotherapy.

Antihypertensive efficacy is greater with adding a second drug. In addition, attainment goal blood pressure is likely to occur more rapidly with the stepped-care approach than with sequential monotherapy.

This is important because most practicing clinicians intensify antihypertensive drugs at only a fraction of the visits at which they encounter an elevated blood pressure reading [ 21, ]. The best data come from a trial of individuals with hypertension who were randomly assigned to initial combination therapy with losartan and hydrochlorothiazide or to sequential monotherapy followed, if needed, by combination therapy [ 11 ].

In the sequential monotherapy group, the dose of the first drug was doubled at four weeks; at eight weeks, the first drug was replaced by the other drug, and the dose of that drug was doubled at twelve weeks.

Starting at 16 weeks, combination therapy was used. Blood pressure reduction was greater with initial combination therapy than with sequential monotherapy, although the blood pressures in the two groups became similar once the sequential monotherapy group was switched to combination therapy [ 11 ].

After the sequential monotherapy group was switched to combination therapy, the control rate increased to match the initial combination therapy group.

By contrast, there is interindividual heterogeneity in the blood pressure response to specific antihypertensive medications [ ], and therefore switching from one drug that has a suboptimal effect to a different drug may lead to improved control [ ].

In addition, there is one trial that reported numerically similar proportions of hypertension control comparing a stepped-care approach with sequential monotherapy [ 10 ].

However, the agents and dosing strategies that were used in this trial were different in the stepped-care and sequential monotherapy groups, limiting the interpretation of this study.

Despite recommendations to add an additional antihypertensive drug when the patient has not attained goal blood pressure, clinicians frequently fail to do this in practice therapeutic inertia.

In the United States, for example, the number of antihypertensive drugs prescribed to adults with hypertension has not changed over the past decade, even though the prevalence of poor hypertension control is high and increasing [ ]. Of those individuals with uncontrolled hypertension, 40 percent are treated with only one antihypertensive medication.

Adding a second drug preferred combination therapy — In most patients who require two antihypertensive agents, the drugs should generally be selected from among the three preferred classes ie, ACE inhibitors [or angiotensin receptor blockers ARBs ], dihydropyridine calcium channel blockers, and thiazide diuretics [ideally a thiazide-like rather than a thiazide-type diuretic].

Conversely, some patients may have an indication for a drug from a different class, as described previously table 2. See 'Choice of initial therapy in patients with comorbidities' above. However, among those without an indication for one of the nonpreferred agents, we suggest treating with the combination of an ACE inhibitor or ARB and a calcium channel blocker, preferably a dihydropyridine calcium blocker.

In addition, we suggest prescribing these two agents as a single-pill combination, if feasible algorithm 1. Patients were randomly assigned to treatment with benazepril 40 mg daily plus amlodipine 5 to 10 mg daily or benazepril plus hydrochlorothiazide At three years, the composite cardiovascular endpoint ie, the combination of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for angina, resuscitation after sudden cardiac death, or coronary revascularization occurred less frequently in the benazepril plus amlodipine group 9.

Benazepril-amlodipine therapy led to a similar reduction in the composite of cardiovascular death or nonfatal myocardial infarction or stroke 5 versus 6. All-cause mortality was slightly less common in the benazepril plus amlodipine group 4.

Although office-based systolic pressure was slightly higher in the group receiving hydrochlorothiazide by 1 mmHg [ 30 ], the hour average ambulatory systolic pressure was 1. Thus, differences in attained blood pressure likely do not account for the totality of the observed benefit from combining benazepril with amlodipine.

In addition to the cardiovascular benefits, kidney events defined as doubling of serum creatinine or end-stage kidney disease [ESKD] were less frequent in patients who were assigned to benazepril plus amlodipine 2 versus 3. However, as noted above, thiazide-like diuretics chlorthalidone and indapamide are more potent and are therefore preferred over thiazide-type diuretics.

Whether combining an ACE inhibitor or ARB with a dihydropyridine calcium channel blocker is superior to combining it with a thiazide-like diuretic is unknown. Nevertheless, because single-pill combinations that contain a thiazide-like diuretic are few and often difficult to obtain, we favor the combination of an ACE inhibitor or ARB plus a dihydropyridine calcium channel blocker when two agents are required.

Adding a third drug if needed — As noted earlier, the three primary options for antihypertensive drug therapy in most patients include an ACE inhibitor or ARB , dihydropyridine calcium channel blocker, and thiazide diuretic preferably a thiazide-like diuretic [ 3 ].

Thus, in patients whose blood pressure is uncontrolled despite adherence to two drugs, we add a drug from the third class of agents. As an example, in a patient who has not attained goal blood pressure despite taking an ACE inhibitor and calcium channel blocker, we add a thiazide-like diuretic.

Some patients may have an indication for a drug from a different class, as described previously table 2. Apparent treatment-resistant hypertension — Patients who are prescribed three antihypertensive drugs at intermediate or high or maximally tolerated doses, inclusive of a diuretic, and who have uncontrolled blood pressure are defined as having apparent treatment-resistant hypertension; those prescribed four or more medications whether or not their blood pressure is controlled are also defined as having apparent treatment-resistant hypertension.

The word "apparent" is used because many such patients have pseudoresistant hypertension eg, due to nonadherence to prescribed therapy or white coat effect. This issue is presented in detail elsewhere. See "Definition, risk factors, and evaluation of resistant hypertension", section on 'Apparent, true, and pseudoresistant hypertension'.

Apparent resistant hypertension is relatively common. As an example, in an analysis of National Health and Nutrition Examination Survey NHANES data through , 22 percent of drug-treated individuals with hypertension were prescribed three or more antihypertensive drugs.

Given that nonadherence and white coat effect are prevalent, the proportion of patients with true resistant hypertension is likely considerably less.

See "Definition, risk factors, and evaluation of resistant hypertension", section on 'Prevalence'. Refractory hypertension is defined as having uncontrolled blood pressure despite prescription of five or more antihypertensive drugs. In one study, approximately 6 percent of those with apparent resistant hypertension had refractory hypertension [ ].

Compared with patients who have apparent resistant hypertension, those with refractory hypertension have higher rates of kidney failure and cardiovascular disease [ ]. In addition, rates of nonadherence to therapy are higher among those with apparent refractory hypertension 60 percent in one study [ ].

See "Definition, risk factors, and evaluation of resistant hypertension", section on 'Refractory hypertension'. The evaluation and treatment of patients with resistant and refractory hypertension is presented separately algorithm 3 and figure 2. See "Definition, risk factors, and evaluation of resistant hypertension" and "Treatment of resistant hypertension".

Waiting four weeks to reevaluate after starting or intensifying therapy is typically appropriate to permit long-acting antihypertensive drugs enough time to manifest their full blood pressure-lowering effect.

Reevaluating at two weeks or even sooner is appropriate for patients with severely elevated blood pressure. If blood pressure is uncontrolled, we typically escalate doses of individual antihypertensive drugs to at least half the maximum recommended dose ie, to a moderate or high dose before adding additional therapy.

After goal blood pressure is attained, we usually follow patients every three to six months either in person or by telehealth. To determine if a patient has attained goal blood pressure, it is important that blood pressure be measured appropriately.

As discussed elsewhere, there are four methods to properly measure blood pressure see "Blood pressure measurement in the diagnosis and management of hypertension in adults", section on 'Our approach to measuring blood pressure' :.

The technology of devices available for self-measured blood pressure has advanced considerably. Now, many home monitors contain memory that automatically stores readings, and some even have the capability of making automated readings while asleep. If home monitoring is performed, the patient should be trained in proper self-measurement technique, and the accuracy of their device should be periodically evaluated eg, annually.

Self-measured blood pressure is discussed in detail elsewhere. See "Out-of-office blood pressure measurement: Ambulatory and self-measured blood pressure monitoring". We monitor electrolytes and serum creatinine one to three weeks after initiation or titration of angiotensin-converting enzyme ACE inhibitors, angiotensin receptor blockers ARBs , mineralocorticoid receptor antagonists, and diuretics table 5.

In patients on stable doses of medications, electrolytes and creatinine are typically monitored annually. OVERVIEW OF ADVERSE EFFECTS — Adverse effects of commonly used antihypertensive drugs are discussed in detail elsewhere table 5 :. BEDTIME VERSUS MORNING DOSING — The contributors to this topic take different approaches to the timing of antihypertensive therapy:.

This approach is supported by the European Society of Hypertension ESH [ ]. Patients with glaucoma, particularly open-angle glaucoma, should not be prescribed antihypertensive medicines at night [ ]. The best data come from the Treatment In the Morning or Evening TIME trial [ ].

In this study, more than 21, adults with hypertension were randomly assigned to take their antihypertensive medications in the morning or the evening. At approximately five years, rates of cardiovascular events were similar between the groups. There were no important differences in safety or adverse events comparing morning with evening dosing.

Although not specifically designed to compare morning with evening dosing, the Colchicine for Prevention of Vascular Inflammation in Noncardioembolic Stroke CONVINCE trial compared sustained release verapamil given at bedtime with an active comparator either hydrochlorothiazide or atenolol , which were dosed in the morning ; there was no difference in the rates of cardiovascular events among the groups [ ].

These data conflict with two other trials the MAPEC and Hygia studies , which concluded that evening dosing leads to fewer cardiovascular events and lower mortality compared with morning dosing [ ,, ]. However, both the MAPEC and Hygia trials were published by the same research group and both trials reported very large benefits from shifting one or more antihypertensive drugs from the morning to bedtime eg, 50 percent or greater relative reductions in stroke, myocardial infarction, and cardiovascular death.

Effects of this magnitude are rarely if ever observed in rigorous cardiovascular trials; in addition, the biologic rationale a modest reduction in nighttime blood pressure without a major difference in hour blood pressure does not support such large effects [ ].

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. See "Society guideline links: Hypertension in adults". These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10 th to 12 th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients.

You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword s of interest. Our approach is as follows see 'Choosing between monotherapy and combination drug therapy' above :.

Combination therapy lowers blood pressure more than monotherapy and increases the likelihood that target blood pressure will be achieved in a reasonable time period. In addition, using two drugs may lead to attainment of goal blood pressure with lower doses of each medication, and this reduces the risk of dose-related side effects.

Such patients include those adhering to a very low salt intake, those who are underweight or frail, those with a known orthostatic decline in blood pressure, and those with a history of multiple drug allergies or intolerances.

However, by far the most important strategy for ultimately achieving blood pressure control is to avoid therapeutic inertia. In most patients, the drugs should be selected from among the three preferred classes ie, angiotensin-converting enzyme [ACE] inhibitors [or angiotensin receptor blockers ARBs ], calcium channel blockers, and thiazide diuretics [ideally a thiazide-like rather than a thiazide-type diuretic].

Among patients without an indication for a specific drug class, we suggest treating with the combination of an ACE inhibitor or ARB and a calcium channel blocker, preferably a dihydropyridine calcium blocker, rather than other combinations Grade 2B.

In addition, we suggest prescribing these two agents as a single-pill combination, if feasible table 1 and algorithm 1 Grade 2B. If there are no compelling reasons to select a specific drug class, we suggest treating with an ACE inhibitor or ARB or a dihydropyridine calcium channel blocker, rather than a thiazide diuretic algorithm 1 Grade 2C.

A thiazide diuretic is a reasonable alternative as monotherapy and may be preferred in patients with edema, osteoporosis, or calcium nephrolithiasis with hypercalciuria. If a thiazide diuretic is used, we suggest treating with a thiazide-like diuretic ie, chlorthalidone , indapamide rather than hydrochlorothiazide Grade 2C.

See 'Patients selected for initial monotherapy' above. Before escalating antihypertensive drug therapy, it is generally prudent to confirm that the patient is adherent and that the blood pressure is truly above goal either with out-of-office blood pressure measurements or a series of properly performed office-based measurements.

See 'Assess medication adherence' above and 'Assure proper blood pressure measurement' above. See 'Uncontrolled on monotherapy' above. As noted above, among those without an indication for one of the nonpreferred agents, we suggest treating with the combination of an ACE inhibitor or ARB and a calcium channel blocker, preferably a dihydropyridine calcium blocker Grade 2B.

In addition, we suggest prescribing these two agents as a single-pill combination, if feasible algorithm 1 Grade 2B. Resistant hypertension is presented in detail elsewhere algorithm 3 and figure 2. See 'Dose titration and monitoring' above. We monitor electrolytes and serum creatinine one to three weeks after initiation or titration of ACE inhibitors, ARBs, mineralocorticoid receptor antagonists, and diuretics table 5.

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View Topic. Font Size Small Normal Large. Choice of drug therapy in primary essential hypertension. Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. View in. Language Chinese English. Authors: Johannes FE Mann, MD John M Flack, MD, MPH, FAHA, FASH, MACP Section Editors: George L Bakris, MD William B White, MD Deputy Editors: Karen Law, MD, FACP John P Forman, MD, MSc Contributor Disclosures.

All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Jan 30, Choice of initial therapy in patients with comorbidities Patients with heart failure — Patients with heart failure may have reduced ejection fraction ie, HFrEF , mildly reduced ejection fraction ie, HFmrEF , or preserved ejection fraction ie, HFpEF.

Circulation ; Yoon SS, Gu Q, Nwankwo T, et al. Trends in blood pressure among adults with hypertension: United States, to Hypertension ; Whelton PK, Carey RM, Aronow WS, et al. Hypertension ; e Mancia G, Kreutz R, Brunström M, et al. J Hypertens ; Flack JM, Calhoun D.

Am J Hypertens ; Wald DS, Morris JK, Wald NJ. Randomized Polypill crossover trial in people aged 50 and over. PLoS One ; 7:e Chow CK, Atkins ER, Hillis GS, et al.

Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension QUARTET : a phase 3, randomised, double-blind, active-controlled trial.

Lancet ; Yusuf S, Joseph P, Dans A, et al. Polypill with or without Aspirin in Persons without Cardiovascular Disease. N Engl J Med ; Egan BM, Bandyopadhyay D, Shaftman SR, et al.

Initial monotherapy and combination therapy and hypertension control the first year. Mourad JJ, Waeber B, Zannad F, et al. MacDonald TM, Williams B, Webb DJ, et al. Combination Therapy Is Superior to Sequential Monotherapy for the Initial Treatment of Hypertension: A Double-Blind Randomized Controlled Trial.

J Am Heart Assoc ; 6. Garjón J, Saiz LC, Azparren A, et al. First-line combination therapy versus first-line monotherapy for primary hypertension.

Cochrane Database Syst Rev ; 2:CD Gradman AH, Basile JN, Carter BL, et al. Combination therapy in hypertension. J Am Soc Hypertens ; Epstein M, Bakris G.

Newer approaches to antihypertensive therapy. Use of fixed-dose combination therapy. Arch Intern Med ; J Clin Hypertens Greenwich ; Leggio M, Fusco A, Loreti C, et al. Fixed and Low-Dose Combinations of Blood Pressure-Lowering Agents: For the Many or the Few?

Drugs ; Parati G, Kjeldsen S, Coca A, et al. Adherence to Single-Pill Versus Free-Equivalent Combination Therapy in Hypertension: A Systematic Review and Meta-Analysis. Weisser B, Predel HG, Gillessen A, et al. High Blood Press Cardiovasc Prev ; Pool JL, Glazer R, Chiang YT, Gatlin M.

Dose-response efficacy of valsartan, a new angiotensin II receptor blocker. J Hum Hypertens ; Brunner HR. Clinical efficacy and tolerability of olmesartan. Clin Ther ; 26 Suppl A:A Josiah Willock R, Miller JB, Mohyi M, et al. Therapeutic Inertia and Treatment Intensification.

Curr Hypertens Rep ; Rose AJ, Berlowitz DR, Orner MB, Kressin NR. Common examples are candesartan , irbesartan , losartan , valsartan and olmesartan.

Possible side effects include dizziness, headaches, and cold or flu-like symptoms. Calcium channel blockers reduce blood pressure by widening your blood vessels. Common examples are amlodipine , felodipine and nifedipine. Other medicines, such as diltiazem and verapamil , are also available.

Drinking grapefruit juice while taking some calcium channel blockers can increase your risk of side effects. Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through your pee. They're often used if calcium channel blockers cause troublesome side effects, or if you have signs of heart failure.

Common examples are indapamide and bendroflumethiazide. Possible side effects include dizziness when standing up, increased thirst, needing to go to the toilet frequently, and a rash. You might also get low potassium and low sodium after long-term use. You'll have regular blood tests to check for this.

Beta blockers can reduce blood pressure by making your heart beat more slowly and with less force. They used to be a popular treatment for high blood pressure, but now tend to be used only when other treatments have not worked.

This is because beta blockers are considered less effective than other blood pressure medicines. Common examples are atenolol and bisoprolol. Possible side effects include dizziness, headaches, tiredness, and cold hands and feet. While there are definite benefits from taking medicines to reduce blood pressure if you're under the age of 80, it's less clear it's useful if you're over It's now thought that if you reach 80 while you're taking medicine for high blood pressure, it's fine to continue treatment provided it's still helping you and is not causing side effects.

If you're diagnosed with high blood pressure and you're aged over 80, your doctor will also consider your other health risk factors when deciding whether to give you treatment for the high blood pressure.

This patient decision aid from the National Institute for Health and Care Excellence NICE PDF, kb can also help you to understand your treatment options. Some people with high blood pressure may also need to take 1 or more medicines to stop their blood pressure getting too high.

If you're diagnosed with high blood pressure, your doctor may recommend taking 1 or more medicines to keep it under control. The medicine recommended for you will depend on things like how high your blood pressure is, your age and your ethnicity.

Page last reviewed: 11 July Next review due: 11 July Home Health A to Z Back to Health A to Z. Overview - High blood pressure hypertension Contents Overview Causes Diagnosis Treatment Prevention.

What is high blood pressure? They're both measured in millimetres of mercury mmHg. Information: Understanding your blood pressure reading If you have a recent blood pressure reading use the NHS Check your blood pressure tool to understand what your reading means.

This causes blood pressure to fall. Movement of calcium into and out of muscle cells is necessary for all muscle contractions. Calcium channel blockers limit calcium from entering the smooth muscle cells of the heart and blood vessels.

This makes the heart beat less forcefully with each beat and helps blood vessels relax. As a result, blood pressure decreases. Your body produces types of hormones called catecholamines when under stress, or chronically in some disease states.

Catecholamines, such as norepinephrine and epinephrine, cause the heart to beat faster and with more force. They also constrict blood vessels. These effects raise blood pressure when the hormones attach to a receptor. The muscles around some blood vessels have what are known as alpha-1 or alpha adrenergic receptors.

When a catecholamine binds to an alpha-1 receptor, the muscle contracts, the blood vessel narrows, and blood pressure rises. Alpha-1 blockers bind to alpha-1 receptors, blocking catecholamines from attaching.

This keeps them from narrowing blood vessels so blood is able to flow through the blood vessels more freely, and blood pressure falls. Alpha-1 blockers are primarily used to treat benign prostatic hyperplasia BPH in men, but are also used to treat high blood pressure.

Alpha-2 receptors are different from alpha-1 receptors. When an alpha-2 receptor is activated, the production of norepinephrine is blocked. This decreases the amount of norepinephrine produced.

Less norepinephrine means less constriction of blood vessels and a lower blood pressure. Methyldopa Aldomet is an example of this type of drug.

Vasodilators relax the muscles in the walls of blood vessels, especially small arteries arterioles. This widens the blood vessels and allows blood to flow through them more easily. Blood pressure falls as a result. Hydralazine hydrochloride Apresoline and minoxidil Loniten are examples of these.

Treatment for high blood pressure includes ongoing care, as well as individual treatments tailored for specific situations and younger age groups, including children and teens. Regular checkups allow your doctor to monitor how well your treatment is going and make any necessary adjustments to your treatment plan.

If your blood pressure starts inching back up, your doctor can respond promptly. Additional treatment options may be needed in certain situations like resistant hypertension or secondary hypertension. Resistant hypertension refers to blood pressure that remains high after trying at least three different types of blood pressure medication.

Someone whose high blood pressure is controlled by taking four different kinds of medication is considered to have resistant hypertension. Even such hard-to-treat cases can often be managed successfully in time. Your doctor might prescribe a different medication, dose, drug combination, or more aggressive lifestyle changes.

Getting a referral to a heart or kidney specialist may also be useful in treating resistant hypertension. Blood pressure often drops substantially or even goes back to normal once doctors diagnose and treat the root cause.

The first line of treatment for children and teens with high blood pressure is a healthy lifestyle. This includes:. Children may take the same blood pressure medications as adults when necessary. For children with secondary hypertension, blood pressure often returns to normal once the underlying condition is treated.

This drug prevents calcium from entering the muscle cells of the heart and arteries. Calcium channel blockers relax and open up narrowed blood vessels, reduce heart rate and lower blood pressure.

These drugs reduce blood pressure by decreasing the activity of the sympathetic adrenaline-producing portion of the involuntary nervous system. Methyldopa is considered a generally safe antihypertensive during pregnancy because adverse effects are infrequent for the pregnant woman or the developing fetus.

Combined alpha and beta-blockers are used as an IV drip for patients experiencing a hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the patient is at risk for heart failure.

Blood vessel dilators, or vasodilators, can cause the muscle in the walls of the blood vessels especially the arterioles to relax, allowing the vessel to dilate, or widen. This allows blood to flow through better.

Written by American Heart Association editorial staff and reviewed by science and medicine advisors. See our editorial policies and staff. High Blood Pressure.

The Facts About HBP. Understanding Blood Pressure Readings. Why HBP is a "Silent Killer". Health Threats from HBP. Changes You Can Make to Manage High Blood Pressure. Baja Tu Presión. Find HBP Tools and Resources. Blood Pressure Toolkit. Home Health Topics High Blood Pressure Changes You Can Make to Manage High Blood Pressure Types of Medications.

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