Blood Pressure Medications Containing Nitrates

Prescription blood pressure drugs come in many classes

Many blood pressure medications, known as antihypertensives, are available by prescription to lower high blood pressure (HBP or hypertension). There are a variety of classes of high blood pressure medications and they include a number of different drugs.

Overviews of the classes of blood pressure medications

Summaries of some of the major types of commonly prescribed cardiovascular medications are provided here.

• For your information and reference, we have included generic names as well as major trade names (noted with a *) to help you identify what you may be taking. However, this information does not signify a recommendation or endorsement from the American Heart Association.
• If your prescription medication isn't on this list, remember that your healthcare provider and pharmacist are your best sources of information.
• It's important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects.
• Never stop taking a medication and never change your dose or frequency without first consulting your doctor.

Patients taking ACE-i and ARBs who contract COVID-19 should continue treatment, unless otherwise advised by their physician

The classes of blood pressure medications include:

• Diuretics
• Beta-blockers
• ACE inhibitors
• Angiotensin II receptor blockers
• Calcium channel blockers
• Alpha blockers
• Alpha-2 Receptor Agonists
• Combined alpha and beta-blockers
• Central agonists
• Peripheral adrenergic inhibitors
• Vasodilators

Diuretics

Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure. They are often used in combination with additional prescription therapies.

Generic name	Common brand names
Thiazide diuretics
chlorthalidone	Hygroton*
chlorothiazide	Diuril*
hydrochlorothiazide	Esidrix*, Hydrodiuril*, Microzide*
indapamide	Lozol*
metolazone	Mykrox*, Zaroxolyn*

Potassium-sparing diuretics
amiloride hydrochloride	Midamar*
spironolactone	Aldactone*
triamterene	Dyrenium*

Loop diuretic
furosemide	Lasix*
bumetanide	Bumex*

Combination diuretics
amiloride hydrochloride + hydrochlorothiazide	Moduretic*
spironolactone + hydrochlorothiazide	Aldactazide*
triamterene + hydrochlorothiazide	Dyazide*, Maxzide*

Some noted possible side effects from diuretics:

• Some of these drugs may decrease your body's supply of the mineral potassium. Symptoms such as weakness, leg cramps or being tired may result. Eating foods containing potassium may help prevent significant potassium loss. If your doctor recommends it, you could prevent potassium loss by taking a liquid or tablet that has potassium along with the diuretic. Diuretics such as amiloride (Midamar)*, spironolactone (Aldactone)* or triamterene (Dyrenium)* are called "potassium sparing" agents. They don't cause the body to lose potassium. They might be prescribed alone, but are usually used with another diuretic. Some of these combinations are Aldactazide*, Dyazide*, Maxzide* or Moduretic*.
• Some people suffer from attacks of gout after prolonged treatment with diuretics. This side effect isn't common and can be managed by other treatment.
• People with diabetes may find that diuretic drugs increase their blood sugar level. A change in medication, diet, insulin or oral anti-diabetic dosage corrects this in most cases.
• Impotence may occur.

Beta-blockers

Beta-blockers reduce the heart rate, the heart's workload and the heart's output of blood, which lowers blood pressure.

Generic name	Common brand names
acebutolol	Sectral*
atenolol	Tenormin*
betaxolol	Kerlone*
bisoprolol fumarate	Zebeta*
carteolol hydrochloride	Cartrol*
metoprolol tartrate	Lopressor*
metoprolol succinate	Toprol-XL*
nadolol	Corgard*
penbutolol sulfate	Levatol*
pindolol*	Visken*
propranolol hydrochloride*	Inderal*
solotol hydrochloride	Betapace*
timolol maleate*	Blocadren*

Combination beta-blocker/diuretic
hydrochlorothiazide and bisoprolol	Ziac*

Some noted possible side effects of beta-blockers:

• Insomnia
• Cold hands and feet
• Tiredness or depression
• Slow heartbeat
• Symptoms of asthma
• Impotence may also occur
• If you have diabetes and you're taking insulin, have your responses to therapy monitored closely.
• If you have been prescribed beta-blockers, consult your healthcare provider prior to conception if you are considering pregnancy or if there is a chance you could become pregnant. If you discover that you are pregnant consult your healthcare provider as soon as possible to determine the safest medication for you at this time.

ACE inhibitors

Angiotensin is a chemical that causes the arteries to become narrow, especially in the kidneys but also throughout the body. ACE stands for Angiotensin-converting enzyme. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure.

Generic name	Common brand names
benazepril hydrochloride	Lotensin*
captopril	Capoten*
enalapril maleate	Vasotec*
fosinopril sodium	Monopril*
lisinopril	Prinivel*, Zestril*
moexipril	Univasc*
perindopril	Aceon*
quinapril hydrochloride	Accupril*
ramipril	Altace*
trandolapril	Mavik*

Some noted possible side effects of ACE inhibitors:

• Skin rash
• Loss of taste
• Chronic dry, hacking cough
• In rare instances, kidney damage
• Women who are taking ACE inhibitors or ARBs for high blood pressure should not become pregnant while on this class of drugs. If you're taking an ACE inhibitor or an ARB and think you might be pregnant, see your doctor immediately. These drugs have been shown to be dangerous to both mother and baby during pregnancy. They can cause low blood pressure, severe kidney failure, excess potassium (hyperkalemia) and even death of the newborn.

Angiotensin II receptor blockers

These drugs block the effects of angiotensin, a chemical that causes the arteries to become narrow. Angiotensin needs a receptor- like a chemical "slot" to fit into or bind with- in order to constrict the blood vessel. ARBs block the receptors so the angiotensin fails to constrict the blood vessel. This means blood vessels stay open and blood pressure is reduced.

Generic name	Common brand names
candesartan	Atacand*
eprosartan mesylate	Teveten*
irbesarten	Avapro*
losartan potassium	Cozaar*
telmisartan	Micardis*
valsartan	Diovan*

Some noted possible side effects of Angiotensin II receptor blockers:

• May cause occasional dizziness.
• ARBs should not be used during pregnancy. Medications that act directly on the renin-angiotensin system can cause injury or even death to a developing fetus. When pregnancy is detected, consult your healthcare professional as soon as possible.

Calcium channel blockers

This drug prevents calcium from entering the smooth muscle cells of the heart and arteries. When calcium enters these cells, it causes a stronger and harder contraction, so by decreasing the calcium, the hearts' contraction is not as forceful. Calcium channel blockers relax and open up narrowed blood vessels, reduce heart rate and lower blood pressure.

Generic name	Common brand names
amlodipine besylate	Norvasc*, Lotrel*
bepridil	Vasocor*
diltiazem hydrochloride	Cardizem CD*, Cardizem SR*, Dilacor XR*, Tiazac*
felodipine	Plendil*
isradipine	DynaCirc*, DynaCirc CR*
nicardipine	Cardene SR*
nifedipine	Adalat CC*, Procardia XL*
nisoldipine	Sular*
verapamil hydrochloride	Calan SR*, Covera HS*, Isoptin SR*, Verelan*

Some noted possible side effects of calcium channel blockers:

• Palpitations
• Swollen ankles
• Constipation
• Headache
• Dizziness

Alpha blockers

These drugs reduce the arteries' resistance, relaxing the muscle tone of the vascular walls.

Generic name	Common brand names
doxazosin mesylate	Cardura*
prazosin hydrochloride	Minipress*
terazosin hydrochloride	Hytrin*

Some noted possible side effects of alpha blockers:

• Fast heart rate
• Dizziness
• A drop in blood pressure when you stand up

Alpha-2 Receptor Agonists

These drugs reduce blood pressure by decreasing the activity of the sympathetic (adrenaline-producing) portion of the involuntary nervous system. Methyldopa is considered a first line antihypertensive during pregnancy because adverse effects are infrequent for the pregnant woman or the developing fetus.

Generic name	Common brand names
methyldopa

Some noted possible side effects of Alpha-2 Receptor Agonists:

• Methyldopa can cause drowsiness or dizziness

Combined alpha and beta-blockers

Combined alpha and beta-blockers are used as an IV drip for those patients experiencing a hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the patient is at risk for heart failure.

Generic name	Common brand names
carvedilol	Coreg*
labetalol hydrochloride	Normodyne*, Trandate*

A noted possible side effect of combined alpha and beta-blockers:

• May cause a drop in blood pressure when you stand up

Central agonists

Central agonists also help decrease the blood vessels' ability to tense up or contract. The central agonists follow a different nerve pathway than the alpha and beta-blockers, but accomplish the same goal of blood pressure reduction.

Generic name	Common brand names
alpha methyldopa	Aldomet*
clonidine hydrochloride	Catapres*
guanabenz acetate	Wytensin*
guanfacine hydrochloride	Tenex*

Some noted possible side effects of central agonists:

• Alpha methyldopa (Aldomet)* may produce a greater drop in blood pressure when you're in an upright position (standing or walking), and it may make you feel weak or faint if the pressure has been lowered too far. This drug may also cause drowsiness or sluggishness, dryness of the mouth, fever or anemia. Male patients may experience impotence. If this side effect persists, your doctor may have to change the drug dosage or use another medication.
• Clonidine (Catapres)*, guanabenz (Wytensin)* or guanfacine (Tenex)* may produce severe dryness of the mouth, constipation or drowsiness. If you're taking any of these drugs, don't stop suddenly because your blood pressure may rise quickly to dangerously high levels.

Peripheral adrenergic inhibitors

These medications reduce blood pressure by blocking neurotransmitters in the brain. This blocks the smooth muscles from getting the "message" to constrict. These drugs are rarely used unless other medications don't help.

Generic name	Common brand names
guanadrel	Hylorel*
guanethidine monosulfate	Ismelin*
reserpine	Serpasil*

Some noted possible side effects of peripheral adrenergic inhibitors:

• Reserpine may cause a stuffy nose, diarrhea or heartburn. These effects aren't severe, and no treatment is required other than to change the dosage. If you have nightmares or insomnia or get depressed, tell your doctor immediately.
• Guanadrel (Hylorel)* or guanethidine (Ismelin)* may cause some diarrhea, which may persist in some people. This side effect usually becomes less of a problem if you continue treatment. These drugs reduce blood pressure more when you stand. Consequently, you may get dizzy and lightheaded and feel weak when you get out of bed in the morning or stand up suddenly. If you notice any of these reactions and if they persist for more than a minute or two, contact your doctor. He/she may instruct you to reduce or omit the next dose of the medication.
• When taking guanethidine, don't stand in the hot sun or at a social gathering if you begin to feel faint or weak. These activities cause low blood pressure and fainting. Male patients may experience impotence. Contact your doctor if either of these side effects occurs.

Blood vessel dilators (vasodilators)

Blood vessel dilators, or vasodilators, can cause the muscle in the walls of the blood vessels (especially the arterioles) to relax, allowing the vessel to dilate (widen). This allows blood to flow through better.

Generic name	Common brand names
hydralazine hydrochloride	Apresoline*
minoxidil	Loniten*†

Some noted possible side effects of vasodilators:

• Hydralazine (Apresoline)* may cause headaches, swelling around the eyes, heart palpitations or aches and pains in the joints. Usually none of these symptoms are severe, and most will go away after a few weeks of treatment. This drug isn't usually used by itself.
• Minoxidil (Loniten)* is a potent drug that's usually used only in resistant cases of severe high blood pressure. It may cause fluid retention (marked weight gain) or excessive hair growth.

† Used in severe cases or when kidney failure is present.

Source: https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications

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