Blood Pressure Medications — All Types Explained (2026)
- There are 5 main classes of blood pressure medication — each works differently
- ACE inhibitors and ARBs are first choice for people with diabetes or kidney disease
- Amlodipine (a calcium channel blocker) is the most commonly prescribed BP drug in the UK
- Most people with hypertension need 2 or more medications to reach target
- Lifestyle changes can reduce BP by 8–14 mmHg — as much as one medication
Why Multiple Drug Classes Exist
Blood pressure is regulated by multiple physiological mechanisms — the renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system, vascular tone, and kidney fluid balance. Different drug classes target different mechanisms, explaining why some patients respond better to one class than another.
The 5 Main Blood Pressure Drug Classes
1. ACE Inhibitors (e.g. Ramipril, Lisinopril)
Block the conversion of angiotensin I to angiotensin II — a potent vasoconstrictor. First choice for: hypertension with Type 2 diabetes, kidney disease, heart failure, post-heart attack. Side effects: dry cough (10–15% — switch to ARB), rare angioedema (stop immediately).
2. ARBs — Angiotensin Receptor Blockers (e.g. Losartan, Candesartan, Valsartan)
Block angiotensin II receptors directly — same clinical benefits as ACE inhibitors without the cough. First choice when ACE inhibitor causes cough. Same indications. Side effects: hyperkalaemia (especially with kidney disease or potassium-sparing diuretics).
3. Calcium Channel Blockers (e.g. Amlodipine, Nifedipine)
Block calcium entry into vascular smooth muscle cells and heart — causing vasodilation and reduced heart rate. Most commonly prescribed first-line in the UK (NHS A-step approach). Side effects: ankle swelling (common), headache, flushing.
4. Beta-Blockers (e.g. Bisoprolol, Atenolol)
Reduce heart rate and cardiac output. Now fourth-line for most hypertension (not preferred first-line). First choice for: heart failure, post-myocardial infarction, rate control in atrial fibrillation. Side effects: fatigue, cold extremities, sexual dysfunction, mask hypoglycaemia symptoms.
5. Thiazide Diuretics (e.g. Indapamide, Bendroflumethiazide)
Increase sodium and water excretion — reducing blood volume. NICE first-line option. Side effects: electrolyte disturbances, gout precipitation, mild glucose elevation.
NICE Step Treatment Approach (UK)
| Step | Under 55 (non-Black) | Over 55 or Black ethnicity |
|---|---|---|
| Step 1 | ACE inhibitor or ARB | Calcium channel blocker |
| Step 2 | + Calcium channel blocker | + ACE inhibitor or ARB |
| Step 3 | + Thiazide diuretic | + Thiazide diuretic |
| Step 4 (resistant) | Add spironolactone, beta-blocker, or alpha-blocker | |