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Medicines for high blood pressure

There are seven groups of active ingredients available for drug therapy for high blood pressure, which can be used individually or in combination. Which drug is used and when is repeatedly adapted by medical societies to the results of current studies (and unfortunately it is not entirely free from the influence of pharmaceutical companies). In addition, the choice of medication depends on the individual comorbidities and tolerability. So is z. B. a beta blocker for blood pressure treatment in patients with bronchial asthma is unfavorable, but highly recommended after a heart attack. Many drugs against high blood pressure act on the renin-angiotensin-aldosterone system (which is responsible, among other things, for the body's own blood pressure regulation): Renin is an enzyme produced in the kidneys that converts angiotensinogen into angiotensin. Angiotensin releases aldosterone, which leads to an increase in blood pressure due to sodium reabsorption and reduced water excretion.

The following Antihypertensive drugs are currently recommended:

  • Diuretics initially promote the excretion of fluids and saline and permanently cause the blood vessels to widen. They are often combined with other high blood pressure medicines. These include B. amiloride, chlortalidone, clopamide, furosemide, hydrochlorothiazide, indapamide, mefruside, piretanide, torasemide, spironolactone, triamterene, xipamide.
  • Beta blockers lower blood pressure by relieving the heart and reducing the heart rate. These include B. Acebutolol, Atenolol, Betaxolol, Bisoprolol, Bupranolol, Carteolol, Carvedilol, Celiprolol, Mepindolol, Metoprolol, Nadolol, Nebivolol, Oxprenolol, Penbutolol, Pindolol, Propranolol, Talinolol.
  • ACE inhibitors lower blood pressure by widening the blood vessels, influencing the heart's activity and increasing the excretion of fluid in the healthy kidney. These include B. Benazepril, Captopril, Cilazapril, Enalapril, Fosinopril, Imidapril, Lisinopril, Moexipril, Perindopril, Quinapril, Ramipril, Spirapril, Trandolapril.
  • AT1 blockers (sartans) act in a similar way to ACE inhibitors and can replace them in the event of intolerance (e.g. irritable cough or Quincke's edema). These include B. candesartan, eprosartan, losartan, irbesartan, olmesartan, telmisartan, valsartan.
  • Calcium channel blockers lower blood pressure by widening the blood vessels; some also slow down the heart rate. These include B. amlodipine, diltiazem, felodipine, gallopamil, isradipine, lacidipine, lercanidipine, manidipine, nicardipine, nifedipine, verapamil. In combination with the antibiotics erythromycin and clarithromycin, however, they increase the risk of shock in elderly patients.

The following are considered reserve drugs today:

  • Alpha 1 blockers (Alpha-receptor blockers) and Antisympathotonics, they directly or indirectly influence the action of the sympathetic nervous system on the vascular tone and thus expand the blood vessels. You are z. B. indicated for hypertension during pregnancy. These include B. bunazosin, clonidine, doxazosin, prazosin, terazosin, urapidil.
  • Substances with a direct vasodilator effect (Vasodilators), which lower blood pressure by lowering arterial resistance. These include B. Dihydralazine, Minoxidil and, as short-acting drugs, nitrates.

It starts with a drug in a low dose, which is gradually increased. If the desired blood pressure cannot be achieved with a drug, a different substance or a combination of active ingredients can be tried out first. In most cases, the desired blood pressure values ​​can be achieved with one or two substances. Three, four or multiple combinations are rarely required. The full effect of high-pressure medication only occurs after 2 to 6 weeks.

Some combinations of active ingredients are already offered by the pharmaceutical industry in a single tablet, so that the number of tablets to be taken daily is reduced.


Dr. med. Dieter Simon, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:40

Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.