Merck Manual

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Antihypertensive Drugs

Antihypertensive Drugs

Type

Examples

Some Side Effects

Adrenergic blockers

Alpha-blockers

  • Doxazosin

  • Prazosin

  • Terazosin

Fainting (syncope) with the first dose, awareness of rapid heartbeats (palpitations), dizziness, low blood pressure when the person stands (orthostatic hypotension), and fluid retention (edema)

Beta-blockers

  • Acebutolol

  • Atenolol

  • Betaxolol

  • Bisoprolol

  • Metoprolol

  • Nadolol

  • Nebivolol

  • Penbutolol

  • Pindolol

  • Propranolol

  • Timolol

Spasm of the airways (bronchospasm), an abnormally slow heart rate (bradycardia), heart failure, possible masking of low blood sugar levels after insulin injections, impaired peripheral circulation, insomnia, fatigue, shortness of breath, depression, Raynaud syndrome, vivid dreams, hallucinations, and sexual dysfunction

With some beta-blockers, an increased triglyceride level

Alpha-beta blockers

  • Carvedilol

  • Labetalol

Low blood pressure when the person stands and spasm of the airways

Angiotensin-converting enzyme (ACE) inhibitors

  • Benazepril

  • Captopril

  • Enalapril

  • Fosinopril

  • Lisinopril

  • Perindopril

  • Quinapril

  • Ramipril

  • Trandolapril

Cough (in up to 20% of people), low blood pressure, an increased potassium level, rash, angioedema (allergic swelling that affects the face, lips, and windpipe and may interfere with breathing), and, in pregnant women, serious injury to the fetus

Angiotensin II receptor blockers (ARBs)

  • Azilsartan

  • Candesartan

  • Eprosartan

  • Irbesartan

  • Losartan

  • Olmesartan

  • Telmisartan

  • Valsartan

Dizziness, an increased potassium level, angioedema (rarer than with ACE inhibitors), and, in pregnant women, serious injury to the fetus

Calcium channel blockers

Dihydropyridines

  • Amlodipine

  • Felodipine

  • Isradipine

  • Nicardipine

  • Nifedipine (sustained-release only)

  • Nisoldipine

Dizziness, fluid retention in the ankles, flushing, headache, heartburn, enlarged gums, and an abnormally fast heart rate (tachycardia)

Nondihydropyridines

  • Diltiazem (sustained-release only)

  • Verapamil

Headache, dizziness, flushing, fluid retention, problems in the heart's electrical conduction system (including heart block), an abnormally slow heart rate (bradycardia), heart failure, and enlarged gums

With verapamil, constipation

Centrally acting alpha-agonists

  • Clonidine

  • Guanabenz

  • Guanfacine

  • Methyldopa

Drowsiness, dry mouth, fatigue, an abnormally slow heart rate, rebound high blood pressure when the drug is withdrawn (except with methyldopa), and sexual dysfunction

With methyldopa, depression, low blood pressure when the person stands, and liver and autoimmune disorders

Direct vasodilators

  • Hydralazine

  • Minoxidil

Headache, an abnormally fast heart rate (tachycardia), and fluid retention

Diuretics

Loop diuretics

  • Bumetanide

  • Furosemide

  • Ethacrynic acid

  • Torsemide

Decreased levels of potassium and magnesium, temporarily increased levels of blood sugar and cholesterol, an increased level of uric acid, sexual dysfunction in men, and digestive upset

Potassium-sparing diuretics

  • Amiloride

  • Eplerenone

  • Spironolactone

  • Triamterene

With all, a high potassium level and digestive upset

With spironolactone, breast enlargement in men (gynecomastia) and menstrual irregularities in women

Thiazide and thiazide-type diuretics

  • Bendroflumethiazide

  • Chlorothiazide

  • Chlorthalidone

  • Hydrochlorothiazide

  • Hydroflumethiazide

  • Indapamide

  • Methyclothiazide

Decreased levels of potassium and magnesium, increased levels of calcium and uric acid, sexual dysfunction in men, and digestive upset