Solving the blood pressure puzzle: the key to understanding blood pressure control through the use of multiple medication types.

The key to solving the blood pressure puzzle


Cardiology, Hypertension, Medicine

When you combine different medications with different mechanisms of action you achieve effective blood pressure control.


Almost one in three people have high blood pressure. Many of them can have it for years without knowing it, because most people that have high blood pressure don’t feel anything. But even if you do not have any symptoms, over time, untreated high blood pressure damages different parts of your body, including your arteries, organs and brain.

Once your doctor has confirmed you have high blood pressure, the next step is to start treatment. Depending on your blood pressure level, your doctor may choose to give you more than just one medication. This is not uncommon. Most people need at least two different medications to treat high blood pressure, and many need three or more. This is because blood pressure medications fit with each other like a jigsaw puzzle. The pieces work together to produce effective combinations. Regardless of the choice of medications, the goals of treatment are always the same:

  • Achieve good blood pressure control

  • Avoid side effects

  • Use as few pills as possible

Knowing what medications you are taking, and what to expect from them, may help you become more comfortable taking them.

Remember one thing:

Most blood pressure medication takes a least one week of constant use to lower blood pressure. This is usually a gradual process. Still, even when your blood pressure is controlled, it will vary throughout the day. Knowing what medications you are taking, and what to expect from them, may help you become more comfortable taking them.

Let’s review the different types of medications available.

Diuretics work with your kidneys to regulate the salts in your body and reduce your blood pressure.
Diuretics, also known as “Water Pills”

Examples: Hydrochlorothiazide, Chlorthalidone

Although these are known as water pills, most people that take them do not feel they need to urinate more. These medications are an essential part of any blood pressure medicine puzzle, and without them it may be hard to achieve good blood pressure control. Side effects are rare, but one uncommon side effect is an alteration in your electrolytes, something your doctor checks on when he draws blood from you.

Beta Blockers

Examples: Atenolol, Metoprolol (and other medications ending in “lol”)
These medications are the equivalent of a handbrake for the body and can slow things down, causing some people to experience fatigue. Also, they can trigger wheezing in patients who struggle with COPD and asthma. That being said, most people who take beta blockers at lower doses do not experience many side effects. By themselves, they rarely lower blood pressure to the desired goal, and often require other pieces to complete the puzzle.

Ace inhibitors like benazapril and enalapril target an important blood pressure regulation system in the body.
“ACE” Inhibitors

Examples: Enalapril, Benazapril (and other medications ending in “pril”)

Ace inhibitors are good alone and better when combined. They can cause coughing for some people who take them. Although this is not a dangerous cough, it can be very bothersome to those who develop it. The cough is dry and itchy, and if you are experiencing it, you should tell your doctor. One of the most important issues with this kind of medication is that it can raise your potassium, especially if your kidneys are not healthy. Your doctor may want to monitor this with a blood test, if that is the case for you.

ARBs or Angiotensin Receptor Blockers, block an importan receptor in the body responsible for salt and blood pressure regulation.
Angiotensin Receptor Blockers

Examples: Losartan, Ibersartan (and other medications ending in “sartan”)

The best thing about these types of medication is that they rarely, if ever, produce any side effects. This is why they were developed. On the other hand, they are not very powerful blood pressure-lowering medications when used alone. Most of them do not lower blood pressure without the addition of other pieces of the puzzle. Like Ace inhibitors, they can raise your potassium, and this becomes a concern if your kidneys are weak.

Calcium channel blockers control blood pressure by dilating blood vessels in the body.
Calcium Channel Blockers

Examples: Amlodipine (and other medications ending with “pine”)

“CCBs,” as they are sometimes called, are a must for every effective blood pressure medicine puzzle. At low doses, they rarely cause any side effects, but at higher doses they can cause swelling in your legs. This is NOT something that will harm you, but it can be very bothersome to those people who experience it.

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Last Modified: Jul 14, 2017 @ 2:00 am
About the Authors

Jose Taveras M.D. F.A.C.C.


Dr. Taveras is a non-invasive cardiologist in the Montefiore-Einstein Center for Heart and Vascular Care in Bronx, New York. He trained in both internal medicine and pediatrics and is currently an assistant professor of medicine at Albert Einstein College of Medicine. Dr. Taveras is a fellow of the American College of Cardiology. He is the co-creator of Doctablet.


Kevin Marzo M.D. F.A.C.C. F.S.C.A.I.

Dr. Marzo is the chief of cardiology at Winthrop University Hospital in Long Island, NY. He specializes in interventional cardiology, including coronary intervention and percutaneous aortic valve replacement as well as in women’s health.

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The key to solving the blood pressure puzzle
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The key to solving the blood pressure puzzle
This tablet discusses the key to controlling high blood pressure: using a combination of medications with different mechanisms of action.
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