Do All High Blood Pressure Medications Have Side Effects?

Steps for Finding Blood Pressure Medications with the Fewest Side Effects

'Male doctor checking woman's blood pressure, mid section'
How can you find the blood pressure medication with the fewest side effect for you?. Darrin Klimek/Digital Vision/Getty Images

Do all high blood pressure medications have side effects? Do you have to cope with symptoms such as a low heart rate, fatigue, or depression? How can you and your doctor find an effective antihypertensive drug which is most tolerable for you specifically?

Blood Pressure Medications and Side Effects

If you've experienced side effects on your high blood pressure medication, the news may be good. There are several different classes of medications used to treat high blood pressure.

While essentially all of these drugs have side effects, the side effects of the particular classes differ widely.

It's important to note, however, that the side effects one person may experience on a blood pressure medication can be different for the next. One person may not experience any side effects on a particular drug, while another may find the side effects so bothersome they wish to discontinue to the drug.

Let's take a look at common side effects, the reason a particular drug may have been prescribed, and finally the most common adverse effects by class of drugs. Using this information, you can work with your doctor to ask further questions in order to find the best drug to meet your needs.

Before talking about specific drugs, let's look at some of the potential side effects which may occur with any of these drugs:

  • Change in heart rate
  • Fatigue
  • Swollen ankles
  • Depression
  • Sexual side effects
  • Asthma

If you know the side effects which are bothering you, take the time to jot them down now.

Choosing a Blood Pressure Medication with the Fewest Side Effects

In order to find the blood pressure medication which is best for you specifically, let's approach the problem in a few steps. Going through these steps will not only help you work with your doctor to find the best drug for you, but will also help you understand the reasons why your doctor has chosen a particular drug, and how that may impact your health.

Step One—What is Your Medication Being Used For?

The first step in finding the right drug is to understand why you need a high blood pressure medication and what else it may be used to treat. Make sure you understand hypertension (high blood pressure) and the risks if it is not treated.

For some people, a medication is needed to lower blood pressure alone. In this case, a drug from nearly any category might be equally effective. The goal, then, is to find a class with the fewest side effects.

Many doctors, however, choose a blood pressure medication which is designed to treat other concerns as well. If you heart rate is normally faster than it should be, your doctor may recommend one drug. If you also have heart failure, a different drug might be recommended. Talking to your doctor about this not only will help you find the drug with the fewest side effects, but will help you understand why one drug class may be better than another for you specifically.

Step Two—What Classes of Drugs Will Accomplish This Purpose?

Once you know the purpose of your high blood pressure medication—whether to lower your blood pressure alone or to help with other problems such as heart failure—which classes of medications might be effective?

Classes of high blood pressure medications commonly used include:

Beta blockers - Beta blockers are used to treat high blood pressure but may also be used to treat heart related conditions such as angina, congestive heart failure, atrial fibrillation, or cardiomyopathy. They may also be used as a preventive medication for people with migraines and to help with social anxiety disorder. Examples include Tenormin (atenolol,) Lopressor (metoprolol,) and Corgard (nadolol.)

Calcium channel blockers - Calcium channel blockers may also be used to treat certain heart arrhythmias, and appear to work particularly well in African Americans.

Examples include Norvasc (amlodipine,) Calan (verapamil,) and Cardizem (diltiazem.)

Angiotensin converting enzyme (ACE) inhibitors - In addition to treating high blood pressure, ACE inhibitors are commonly used after a heart attack, for heart failure, and to treat kidney problems in people with diabetes. Examples include Vasotec (enalapril,) and Prinivil (lisinopril.)

Angiotensin II receptor blockers - Angiotensin II receptor blockers like ACE inhibitors may be used for heart failure and kidney problems in addition to high blood pressure. Examples include Cozaar (losartan,) and Diovan (valsartan.)

Thiazide diuretics - Diuretics such as hydrochlorothiazide have been used for high blood pressure for decades. As "water pills," diuretics may help with fluid retention.

Other high blood pressure medications - There are several other classes of medication which may be used for high blood pressure including alpha blockers, renin inhibitors, central agonists, vasodilators and more.

ACE inhibitors and angiotensin receptor blockers may be best for someone who has kidney problems

Beta blockers are usually avoided in people with asthma or COPD due to the presence of beta receptors in the lungs as well as the heart. Cardioselective beta blockers, however, may be an option.

Younger people tend to do better on ACE inhibitors, angiotensin II receptor blockers, and beta blockers. Those who may become pregnant should avoid ACE inhibitors and angiotensin II receptor blockers as these may lead to birth defects.

Step Three—Which Side Effects are Most Bothersome to You?

Knowing that most medications will have some side effects, the next step is to think about which side effects are most bothersome to you. Is it fatigue? Are the sexual side effects of a drug bothersome? Some people would rather cope with constipation than swelling in their ankles. Others would tolerate a little fatigue if that means not having to follow a restricted diet (such as eliminating grapefruit) on another drug.

Some of the more common side effects of five classes of high blood pressure medications include:

Beta blockers

  • Worsening of symptoms for those with COPD and asthma
  • Risk of low blood sugar in people with diabetes
  • Worsening of peripheral artery disease
  • Depression
  • Sexual dysfunction
  • Fatigue
  • Cold hands and feet
  • Since beta blockers block an increase in heart rate with activity, they are not a good choice for someone who enjoys extreme sports

Calcium channel blockers

  • Dietary restrictions
  • Palpitations due to abnormal heart rhythms (especially in those who smoke)
  • Constipation
  • Swelling of the lower extremities
  • Headache

ACE inhibitors

  • Cough - An annoying dry cough on ACE inhibitors is a relatively common side effect
  • Allergic reactions, swelling of the face and neck (angioedema)
  • Loss of the sense of taste
  • Increased potassium levels

Angiotensin II receptor blockers

  • Allergic reactions/angioedema
  • Weight loss
  • Lightheadedness or dizziness
  • Sinus symptoms
  • Increased potassium levels

Thiazide diuretics

  • Low potassium levels
  • Muscle aches and cramps (related to potassium levels)
  • Frequent urination
  • Blurred vision
  • Sexual dysfunction
  • Gout (pain in joints, especially the great toe)

Step Four—Which Class of Medications (and Specific Drugs) Accomplish Both Your Purpose and Has the Fewest Side Effects You Dislike?

Certainly every class of high blood pressure medications can have side effects, and the drugs within the classes can vary. Yet knowing which side effects are most annoying for you, and combining that with other uses of the drugs (such as for angina) and the most common side effects of the drugs, can give you and your doctor guidance in making a wise choice.

A Few More Points in Reducing Side Effects from Blood Pressure Medications

There are a few more things to consider if the side effects of your blood pressure medication are bothersome:

  • If you are experiencing sexual side effects or sleep disturbances, could you take your medication at a different time of the day? The blood levels of medications vary depending on when they are taken.
  • Are there any treatments which could reduce the side effects you are experiencing without discontinuing the drug?
  • Have you changed from a brand name drug to a generic, or from one generic drug to another? Some people notice changes when switched to generic drugs.
  • Don't forget about possible drug interactions. The more medications you take, the more likely that a side effect is related to the combination of medications rather than one single drug.

Bottom Line on Finding the Best (and Most Side Effect Free) High Blood Pressure Drug

Everyone is different when it comes to the side effects they will experience, as well as those which are most annoying, on a particular blood pressure medication. Sometimes it can take some hit or miss—trying different drugs—until the right medication or combination of medications is found. Knowing the differences in classes and your own preferences is a good place to start. Here are a few more tips on choosing the blood pressure medication which is right for you.


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Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.

Paz, M., de-La-Sierra, A., Saez, M. et al. Treatment Efficacy of Anti-Hypertensive Drugs in Monotherapy or Combination: ATO< Systematic Review and Meta-Analysis of Randomized Clinical Trials According to PRISMA Statement. Medicine (Baltimore). 2016. 95(30):e4071.

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