Hypertension is one of the most common chronic diseases in the United States, affecting nearly 120 million adults (about 48%). If left uncontrolled, hypertension significantly increases the risk of serious diseases such as heart disease, stroke, and kidney failure. Fortunately, modern medicine offers a variety of effective antihypertensive medications to help patients manage their blood pressure.

This article will introduce the commonly used types of antihypertensive medications in the U.S., suitable populations, side effects, and the latest treatment trends. Below are the five most commonly used classes of antihypertensive medications in the U.S.:

1. ACE Inhibitors
2. ARBs (Angiotensin II Receptor Blockers)
3. Calcium Channel Blockers (CCBs)
4. Diuretics
5. Beta-Blockers

1. Common Types of Antihypertensive Medications in the U.S.

Antihypertensive medications primarily lower blood pressure through different mechanisms, and doctors will choose the appropriate medication based on factors such as the patient's age, race, and complications.

(1) ACE Inhibitors

Representative Drugs: Lisinopril, Enalapril, Ramipril
Mechanism of Action: Inhibit the angiotensin-converting enzyme (ACE), reducing vasoconstriction and lowering blood pressure.
Suitable Population:

• Patients with hypertension combined with diabetes, chronic kidney disease, or heart failure.
• White patients (more effective compared to ARBs).

Common Side Effects:

• Dry cough (occurs in about 20% of patients).
• Elevated potassium levels (requires monitoring of kidney function).

(2) ARBs (Angiotensin II Receptor Blockers)

Representative Drugs: Losartan, Valsartan, Irbesartan
Mechanism of Action: Block angiotensin II receptors, relaxing blood vessels.
Suitable Population:

• Patients who cannot tolerate ACE inhibitors (e.g., due to dry cough).
• Patients with hypertension combined with diabetes or left ventricular hypertrophy.

Advantages:

• Lower risk of dry cough.
• Strong protective effect on the kidneys.

(3) Calcium Channel Blockers (CCBs)

Representative Drugs: Amlodipine, Diltiazem, Verapamil
Mechanism of Action: Prevent calcium from entering vascular smooth muscle cells, causing vasodilation.
Suitable Population:

• African American patients (more effective than other antihypertensives).
• Elderly patients with hypertension.
• Patients with angina.

Common Side Effects:

• Ankle edema (common with Amlodipine).
• Constipation (more pronounced with Verapamil).

(4) Diuretics

Representative Drugs: Hydrochlorothiazide (HCTZ), Furosemide, Spironolactone
Mechanism of Action: Promote sodium and water excretion by the kidneys, reducing blood volume and lowering blood pressure.
Suitable Population:

• Mild hypertension (HCTZ is commonly used for initial treatment).
• Patients with edema or heart failure (Furosemide is used for severe fluid retention).

Side Effects:

• Low potassium levels (may require potassium supplementation or combination with potassium-sparing diuretics).
• Elevated uric acid levels (may trigger gout).

(5) Beta-Blockers

Representative Drugs: Metoprolol, Atenolol, Carvedilol
Mechanism of Action: Slow heart rate and reduce cardiac workload.
Suitable Population:

• Patients with hypertension combined with coronary artery disease, heart failure, or arrhythmias.
• Young patients with hypertension (especially those with overactive sympathetic nervous systems).

Side Effects:

• Fatigue, sexual dysfunction.
• Caution in asthma patients (may exacerbate bronchospasm).

Modern hypertension treatment emphasizes individualized medication, with about 70% of patients requiring a combination of two or more antihypertensive medications to achieve optimal results. Common combination regimens include ACE inhibitors or ARBs combined with diuretics, or calcium channel blockers combined with ARBs. Recent research indicates that genetic testing can help predict patients' responses to different types of antihypertensive medications, enabling more precise personalized treatment. For resistant hypertension, new medications like ARNI (sacubitril/valsartan) have also shown good antihypertensive effects. Regardless of the chosen medication, regular blood pressure monitoring and following medical advice for adjusting medication regimens are key to ensuring treatment effectiveness.

Latest Treatment Trends:

• Genetic testing guiding personalized medication.
• New medications like ARNI (sacubitril/valsartan) showing good effects.
• Dynamic blood pressure monitoring optimizing medication regimens.

Precautions:

• Regularly monitor blood pressure changes.
• Follow medical advice for medication adjustments.
• Be aware of potential medication side effects.
• Maintain a healthy lifestyle.