Blood Pressure Medicines: 3 More Things to Know
Based on American Heart Association, Monitoring Your Blood Pressure at Home
The standard next steps when lisinopril, losartan or amlodipine is not enough, where beta blockers fit, and what to check when pressure stays high on three medicines.
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In this guide
Where Beta Blockers Fit
- Not first-line for most people
- Used after a heart attack or heart failure
- Propranolol for anxiety: a different job
Pregnancy and Swelling
- No ACE inhibitors or ARBs in pregnancy
- Pregnant or planning? Tell us right away
- Lip, tongue or throat swelling: call 911
A Reading Over 180/120
- Wait one minute and check again
- Symptoms like chest pain? Call 911
- No symptoms? Call your provider now
What the guideline says
- Many people need more than one medicine to reach their blood pressure goal, and two medicines at moderate doses usually work better, with fewer side effects, than one pushed to its maximum.
- The main first-line medicines are ACE inhibitors such as lisinopril, ARBs such as losartan, calcium channel blockers such as amlodipine and thiazide-type diuretics such as chlorthalidone and hydrochlorothiazide.
- An ACE inhibitor and an ARB should not be taken together, and neither should be used in pregnancy.
- Swelling of the lips, tongue, face or throat on an ACE inhibitor is an emergency; call 911.
- Beta blockers such as metoprolol are not first-line for most people with uncomplicated high blood pressure, but they are the right choice after a heart attack, with heart failure or with certain heart rhythms.
- Blood pressure that stays high on three medicines, including a diuretic, is called resistant hypertension, and it calls for checking home readings, how doses are taken and hidden causes such as sleep apnea.
Source: American Heart Association, Monitoring Your Blood Pressure at Home
Read the full article: Adding a Second Blood Pressure Medication to Lisinopril or Amlodipine →
This guide is general health information and does not replace advice from your own provider.
Frequently Asked Questions
Blood pressure that stays high on three medicines, including a diuretic. Before adding more, your care team checks that home readings are accurate, that doses are taken as planned, and for hidden causes.
Sleep apnea, high sodium intake, alcohol, pain relievers like ibuprofen, or a hormone condition called primary aldosteronism.
No. ACE inhibitors such as lisinopril and ARBs such as losartan must not be used in pregnancy. Tell your provider right away if you are pregnant or planning to be.