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Which High Blood Pressure Medicine is the Best?

Recommendations for First Line Therapy

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Updated May 16, 2014

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High blood pressure treatment consists of several distinct, but related, types of actions. Typically, these include:

Most People with High Blood Pressure Need Drug Therapy

While quitting smoking, changing your diet and starting an exercise program are all beneficial and provide a concrete and proven way to improve your blood pressure profile, drug therapy is often a vital piece of the puzzle. The most popular blood pressure medications used in the United States are:

Which Drug is the Best?

Most patients with high blood pressure are on some type of drug therapy. Depending on the patient, this may mean taking a single pill or could mean a regimen of several different types of medicine taken at different times. Because there are so many different types of blood pressure medication available, and so many possible ways to combine them, patients - especially new high blood pressure patients - often wonder if there is specific drug that is "the best." The Answer: Maybe.

Special Circumstances

If you have diabetes or kidney disease, research seems to suggest that the ACE Inhibitors and Angiotensin Receptor Blockers are a good choice. Studies have shown that these drugs seem to offer protective effects for the kidneys aside from their ability to lower blood pressure. Still, remember that lowering the blood pressure is the ultimate goal. If these medicines aren't doing a good job lowering your blood pressure, then you should switch to or add one that's more effective. In other words, the damage that can be caused by continued high blood pressure more than outweighs any protective effect that these medicines may offer your kidneys.

No Clear Recommendation for Most Patients

While some specific patients may benefit from using a particular class of high blood pressure medicine, there is no single recommendation on which drug should be "the best" or which drug should be used first when treating high blood pressure in most patients. A series of large clinical studies, including the CAPPP, STOP-Hypertension-2, NORDIL, UKPDS, and INSIGHT trials found little overall difference in outcome when comparing the various types of high blood pressure medicines.

One trial, the ASCOT trial, did show a lower risk of cardiovascular disease and cardiovascular-related death with the use of calcium channel blockers as compared to beta blockers. However, when this data was reexamined, it was found that the apparent lower risk was likely attributable to an overall lower blood pressure in that study's sample patients.

The Best Drug is the One that Works!

The bottom line is that the "best" drug for you is the one that is most effective at lowering your blood pressure without causing unwanted side effects. There are various specific reports about the benefits and potential harms of each of the specific classes of blood pressure medicines, but there is a huge volume of evidence supporting the fact that high blood pressure is deadly, and that lowering blood pressure saves lives. In the end, that is the true goal.

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