High blood pressure is one of the most common health problems in the world.
According to the World Health Organization, around 1.4 billion people were living with hypertension in 2024.
Despite the availability of effective treatments, only a little more than one in five people with high blood pressure have their condition under control.
This gap is a major public health concern because uncontrolled high blood pressure increases the risk of heart attacks, strokes, heart failure, kidney disease, and dementia. Often called the “silent killer,” hypertension usually causes no symptoms until serious damage has already occurred.
One of the biggest challenges in treating high blood pressure is not the lack of medication. Instead, it is getting people to continue taking their medications over the long term.
Many patients stop treatment because they experience side effects or worry about developing them. Some people refuse higher doses, while others discontinue treatment completely after only a few months.
To better understand which medications people tolerate best, researchers conducted one of the largest analyses ever performed on blood pressure treatments. The findings were published in JAMA and included data from 159,362 participants.
The researchers examined a wide range of blood pressure medications and medication combinations. Their goal was to identify which treatments caused the fewest side effects and which were most likely to be continued by patients.
High blood pressure medications lower blood pressure in different ways. Angiotensin II receptor blockers, often called ARBs, work by blocking a hormone that narrows blood vessels. When this hormone is blocked, blood vessels relax and blood flows more easily.
Beta blockers work differently. They slow the heart rate and reduce the force with which the heart pumps blood. Calcium channel blockers, commonly called CCBs, prevent calcium from entering certain cells in the heart and blood vessels, helping blood vessels relax.
Although all of these medications can effectively lower blood pressure, patients do not necessarily tolerate them equally well.
To compare treatments, researchers analyzed 716 randomized, double-blind clinical trials. The studies lasted between four and 26 weeks and included patients receiving different blood pressure medications alone or in combination.
The main question was simple: how often did people stop taking their medication because of side effects? The researchers also looked at common complaints such as headaches, dizziness, swelling, and coughing.
After combining all the data, they created rankings showing which medications were easiest for patients to tolerate.
The results clearly favored ARBs. These medications had the lowest rates of treatment discontinuation. In fact, people taking ARBs were even less likely to stop treatment than those taking placebo pills.
The best-performing treatment overall was a combination of an ARB and a calcium channel blocker. This combination achieved the highest ranking for tolerability.
ARBs appeared among four of the top five best-tolerated treatment options. This finding suggests they may be particularly useful for patients concerned about medication side effects.
In contrast, treatments containing calcium channel blockers alone were more likely to cause side effects that led people to stop treatment. Certain combinations, including beta blockers paired with diuretics, also had relatively high discontinuation rates.
An interesting finding involved headaches. Most blood pressure medications were associated with fewer headaches than placebo. The main exception was calcium channel blockers, which appeared more likely to trigger headaches. Researchers believe this may happen because these drugs widen blood vessels in the brain.
The findings are important because medication adherence remains one of the greatest obstacles in hypertension treatment. Studies show that between 30% and 80% of people newly prescribed blood pressure medication stop taking it within the first year.
If you care about high blood pressure, please read studies that early time-restricted eating could help improve blood pressure, and coconut sugar could help reduce blood pressure and artery stiffness.
For more information about blood pressure, please see recent studies about added sugar in your diet linked to higher blood pressure, and results showing plant-based foods could benefit people with high blood pressure.
