Medication options for stage 1 high blood pressure (140/90 to

159/99 mm Hg)
If you have stage 1 high blood pressure, you have a systolic pressure ranging from 140 to 159
mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg. If both numbers are in this range,
you also have stage 1 high blood pressure. The first change you can make is to adopt healthy
lifestyle changes to help decrease your numbers. Your doctor will likely prescribe medications,
as well. Your choices include:

Diuretics (water pills). Your doctor may first suggest diuretics also called water pills.
Diuretics work by flushing excess water and sodium from the body, thus lowering blood
pressure, which may be enough along with lifestyle changes to control your blood pressure.

Although three types of diuretics are available, the first choice is usually a thiazide diuretic.
Thiazide diuretics typically have fewer side effects than do other types of diuretics. They also
offer strong protection against conditions that high blood pressure can cause, such as stroke
and heart failure. A diuretic may be the only high blood pressure medication you need. But
under some circumstances, your doctor may recommend a different first line medication or
may add another medication.

Angiotensin-converting enzyme (ACE) inhibitors. These allow blood vessels to widen by

preventing the formation of a hormone called angiotensin. Frequently prescribed ACE
inhibitors include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and ramipril (Altace).
Angiotensin II receptor blockers. These help blood vessels relax by blocking the action of
angiotensin. Frequently prescribed angiotensin II receptor blockers include losartan
(Cozaar), candesartan (Atacand) and valsartan (Diovan).
Beta blockers. These work by blocking certain nerve and hormonal signals to the heart and
blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include
metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and atenolol (Tenormin).
Calcium channel blockers. These prevent calcium from going into heart and blood vessel
muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently
prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem,
Dilacor XR) and nifedipine (Adalat CC, Procardia).
Renin inhibitors. Renin is an enzyme produced by your kidneys that starts a chain of
chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the
production of renin, reducing its ability to begin this process. Due to a risk of serious
complications, including stroke, you shouldn't take aliskiren along with ACE inhibitors or
angiotensin II receptor blockers if you have diabetes or kidney disease.
Adding one of these medications may lower your blood pressure more effectively than if you
take only a diuretic. This may reduce the risk of developing complications from high blood
pressure. Combining two medications of different classes may allow you to take a smaller dose
of each, which can reduce side effects and perhaps be less expensive. The choice of
medications in combination depends on your individual circumstances.