Side Effects of High Blood Pressure Medication

High blood pressure medication can help you lower your blood pressure and prevent high blood pressure complications. Although these medications can save your life, they have potential side effects. However, most side effects are manageable, especially if you know what to expect from your medicine.

Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors can help lower blood pressure, treat congestive heart failure, and prevent kidney damage in some people. They work by blocking an enzyme in your body that produces angiotensin II. Angiotensin II narrows blood vessels and stimulates your body to retain water and sodium, which raises your blood pressure.

Examples of ACE inhibitors include:

• benazepril (Lotensin)
• enalapril (Vasotec)
• lisinopril (Prinivil, Zestril)
• quinapril (Accupril)
• ramipril (Altace)

ACE inhibitors are generally well tolerated. However, the following are a few side effects that may occur with ACE inhibitors:

• Dry cough: About 1 in 10 people who take ACE inhibitors develop a dry, irritating cough. ACE inhibitors stimulate the production of bradykinin, an inflammatory substance that produces this cough. Talk to your provider if you develop a cough while taking this medicine. Your doctor may change your medication. It may take 8 to 12 weeks for the cough to go away after you stop taking the ACE inhibitor.
• Dizziness: Dizziness or lightheadedness is rare with ACE inhibitors. However, if your blood pressure is too low, you may experience dizziness. This is more likely to happen if you have heart problems and are beginning or changing an ACE inhibitor. Always get up slowly and carefully. When rising from bed, sit up first and hold on to something sturdy before standing up.
• High potassium: ACE inhibitors lower aldosterone levels in the kidneys. Aldosterone is a hormone that helps regulate your potassium levels. Low aldosterone levels may increase potassium in your kidneys and bloodstream. Your doctor may check your potassium levels regularly if you are taking an ACE inhibitor. Symptoms of high potassium include weakness, confusion, and muscle cramps.
• Swelling: Bradykinin, the same substance that may produce a cough, can also cause fluid retention or swelling. Swelling with ACE inhibitors ranges from mild swelling of the lips, tongue, or mouth to severe swelling of the airways that requires emergency treatment. If you experience swelling with an ACE inhibitor, you should stop the medication and talk to your doctor about changing to a different medication class.
• Changes in taste: A chemical in ACE inhibitors may cause a metallic taste in your mouth. This does not happen with all ACE inhibitors and often goes away after you’ve been taking the medicine for some time.

Angiotensin II Receptor Blockers

Angiotensin II receptor blockers (ARBs) block the effects of angiotensin II and bypass the enzyme where ACE inhibitors work. Consequently, ARBs do not produce the cough or swelling that ACE inhibitors can cause. If you must stop taking an ACE inhibitor because of side effects, your healthcare provider may prescribe an ARB instead.

Commonly used ARBs include:

• candesartan (Atacand)
• irbesartan (Avapro)
• losartan (Cozaar)
• olmesartan (Benicar)
• telmisartan (Micardis)
• valsartan (Diovan)

Although side effects with ARBs are uncommon, the following are potential side effects to be aware of:

• Dizziness: Dizziness or lightheadedness may occur with any blood pressure medication, especially as your body gets used to the medicine. To avoid sudden drops in blood pressure, do not rise suddenly from a sitting or lying position.
• High potassium: ARBs may increase your potassium levels in the same manner that ACE inhibitors do. Be sure to check your potassium levels regularly if you are taking an ARB.
• Stomach problems: Some people who take ARBs may experience nausea or diarrhea. Contact your healthcare provider if you have severe diarrhea.
• Swelling: There is a small chance that ARBs may cause swelling of the face or airways. However, this is much less likely to happen with ARBs than with ACE inhibitors.

Beta-Blockers

Beta-blockers have been used for decades to lower blood pressure, decrease heart rate, and control some types of tremors. Beta-blockers help lower blood pressure by blocking the beta receptors for adrenaline. Blocking these receptors stops the action of adrenaline and relaxes blood vessels, lowers blood pressure, and slows down your heart rate.

Examples of commonly used beta-blockers include:

• atenolol (Tenormin)
• bisoprolol (Zebeta)
• metoprolol (Lopressor, Toprol XL)
• nadolol (Corgard)
• nebivolol (Bystolic)
• propranolol (Inderal)

Side effects of beta-blockers are mainly due to the medication's acting on beta-receptors in different parts of your body. Generally, the side effects of beta-blockers worsen as the dose increases. It is best to start with a low dose and increase gradually to avoid unwanted side effects.

Common side effects of beta-blockers include:

• Cold hands or feet
• Depression
• Dizziness
• Headache
• Shortness of breath
• Tiredness
• Weight gain

Calcium Channel Blockers

Calcium channel blockers can lower your blood pressure and regulate your heart rhythm. They work by blocking calcium from entering your heart cells. This allows blood vessels to relax and slows down your heart rate.

Examples of calcium channel blockers include:

• amlodipine (Norvasc)
• diltiazem (Cardizem, Tiazac, and others)
• felodipine (Plendil)
• nifedipine (Adalat CC, Procardia)
• verapamil (Calan, Verelan)

Potential side effects of calcium channel blockers include:

• Constipation: Verapamil is more likely to cause constipation than other calcium channel blockers.
• Dizziness: As with other blood pressure medicines, dizziness or lightheadedness may occur as your body gets used to the medication.
• Flushing: Flushing occurs as the medication opens your blood vessels. Flushing is more likely to happen with nifedipine. If you experience intolerable flushing, talk to your doctor about switching to a different calcium channel blocker.
• Headache: Headaches can also occur due to the widening of blood vessels.
• Heart fluttering: Opening of your blood vessels may sometimes affect your heartbeat. Some people taking calcium channel blockers may experience heart fluttering or rapid heartbeat.
• Nausea: Verapamil is more likely to cause nausea and other stomach side effects.
• Swelling of the feet or lower legs: Swelling, especially in the lower extremities, is a common side effect of calcium channel blockers. Nifedipine is more likely to cause swelling than other medications in this class.

No matter what blood pressure medication you take, it is important to know the potential side effects you may experience from your medicine. Blood pressure medications are life-saving drugs, and knowing what to expect from them will help you use your medicine correctly.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200815/

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