The common side effects of
some anti-hypertension drugs
Anti-hypertensive Drugs

Anti-hypertensive (or blood pressure-lowering) drugs can help control blood pressure when
diet and physical activity alone have not succeeded. However, they always come with lots of
side effects. Blood pressure-lowering drugs are divided into seven groups and they are
diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotension-2 receptor
antagonists, beta blockers, calcium channel blockers, alpha blockers and central alpha
agonists.

Diuretics

Diuretics lower blood pressure by causing the body to rid itself of excess fluids and sodium
through urination. If the prescribed diuretics can not achieve the desired effects, combination
with other anti-hypertensive agent is also used to enhance the effects. Some commonly
prescribed diuretics are Amiloride (Midamor), Bumetanide (Bumex), Chlorothiazide (Diuril),
Chlorthalidone (Hygroton), Furosemide (Lasix), Hydrochlorothiazide (Esidrix, Hydrodiuril),
Indapamide (Lozol) and Spironolactone (Aldactone).  Common side effects of diuretics
include low sodium in the blood (hyponatremia), increased blood sugar, increased
cholesterol, rash, joint disorders (gout), impotence in men, menstrual irregularities, and
breast enlargement in men (gynecomastia). [2]

Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors expand blood vessels and thus decrease resistance. This allows blood to
flow more easily and makes the heart's work easier or more efficient. ACE inhibitors are used
to treat symptoms of heart failure and to lower blood pressure. You should not take ACE
inhibitors if you are pregnant. Commonly prescribed ACE inhibitors include: Benazepril
(Lotensin), Captopril (Capoten), Enalapril (Vasotec), Fosinopril (Monopril), Lisinopril (Prinivil,
Zestril), Moexipril (Univasc), Perindopril (Aceon), Quinapril (Accupril), Ramipril (Altace) and
Trandolapril (Mavik) The major potential risks and side effects of ACE inhibitor therapy are
birth defects (or death of an unborn baby), kidney problems (symptoms are sudden weight
gain, swelling of arms, hands, and feet). The most common side effects with ACE inhibitors
are dizziness, dry cough and sore throat. [1]

Angiotensin-2 Receptor Antagonists

Angiotensin-2 (AT-2) receptor antagonists also expand blood vessels. But, user can tolerate
them better because these drugs produce less cough as ACE inhibitors do. AT-2 receptor
antagonists do not lower levels of angiotensin II (as ACE inhbitor do), they prevent
angiotensin II from having any effects on the heart and blood vessels. This is how it keeps
blood pressure from rising. You should not take ACE inhibitors if you are pregnant.
Commonly prescribed angiotensin-2 receptor antagonists include: Candesartan (Atacand),
Eprosartan (Teveten), Irbesartan (Avapro), Losartan (Cozaar), Telmisartan (Micardis) and
Valsartan (Diovan). The common side effects among angiotensin-2 receptor antagonists are
back pain, cold-like symptoms, sore throat, stuffy nose, sinus inflammation, diarrhea and
dizziness.

Beta Blockers

Beta-blockers work differently. They decrease the heart rate and cardiac output to lower blood
pressure. They're also used to treat cardiac arrhythmias and angina pectoris. Commonly
prescribed beta-blockers include: Acebutolol (Sectral), Atenolol (Tenormin), Betaxolol
(Kerlone), Bisoprolol/hydrochlorothiazide (Ziac), Bisoprolol (Zebeta), Carteolol (Cartrol),
Metoprolol (Lopressor, Toprol XL), Nadolol (Corgard), Propranolol (Inderal), Sotalol
(Betapace) and Timolol (Blocadren). Their common side effects, in general, are bradycardia,
congestive heart failure, hypotension, joint/back pain, liver abnormalities, fatigue, dizziness,
nausea, colitis, constipation, diarrhea, allergy, systemic lupus erythematosus, urticaria etc.
Please, note that the manifestation of the types of side effects vary from product to product
and from patient to patient.

Calcium Channel Blockers

Calcium channel blockers (or calcium antagonists) interrupt the movement of calcium into
heart and vessel cells. They're used to treat hypertension, angina and/or some arrhythmias.
Commonly prescribed calcium channel blockers include: Amlodipine (Norvasc, Lotrel),
Bepridil (Vascor), Diltiazem (Cardizem, Tiazac), Felodipine (Plendil), Nifedipine (Adalat),
Nimodipine (Nimotop), Nisoldipine (Sular) and Verapamil (Calan, Isoptin, Verelan)

The most common-frequent adverse effect experienced by users are headache, flushing and
peripheral (or lower-limb) edema. Other common adverse side effects are dizziness, nausea,
constipation, vertigo, rash, leg cramps, allergy, bradycardia, cardiac arrest, hypotension,
palpitations, tachycardia, anxiety, dry mouth, dyspepsia, abdominal pain, cough, arthritis, joint
disorder, abnormal vision, dysuria, kidney calculus, nocturia, polyuria, impotence, urinary
frequency or even first-degree atrioventricular block.

Alpha Blockers

Alpha blockers include Doxazosin mesylate (Cardura), Prazosin hydrochloride (Minipress)
and Terazosin hydrochloride (Hytrin). The common side effects of Cardura include dizziness,
fatigue, hypotension, edema and dyspnea. The most frequent reactions associated with
Minipress therapy are dizziness, headache, drowsiness, lack of energy, weakness,
palpitations and nausea. The common side effects for Hytrin are asthenia, postural
hypotension, dizziness, somnolence, nasal congestion/rhinitis, and impotence.

Central Alpha Agonists

Examples of central alpha agonists are Clonidine hydrochloride (Catapres), Clonidine
hydrochloride and chlorthalidone (Clorpres, Combipres), Guanfacine hydrochloride (Tenex),
Methyldopa (Aldomet), Methyldopa and chlorothiazide (Aldochlor) and Methyldopa and
hydrochlorothiazide (Aldoril). Common side effects of this group of drugs include sedation,
headache, asthenia (or weakness), aggravation of angina pectoris, congestive heart failure,
prolonged carotid sinus, pancreatitis, colitis, vomiting, diarrhea, bone marrow depression,
leucopenia, liver disorders, hypersensitivities, Parkinsonism and Bell's palsy etc. Some may
experience dry mouth, drowsiness, dizziness, constipation, depression, vomiting, anorexia
and loss of libido.

To decrease the side effect or to improve the therapeutic effect of drugs, manufacturers
combine two different drugs:

(1) Angiiotensin II receptor antagonist/diuretic

* Irbesartan and hydrochlorothiazide (Avalide)
* Losartan and hydrochlorothiazide (Hyzaar)
* Valsartan and hydrochlorothiazide (Diovan HCT)

(2) ACE Inhibitor/Calcium Channel Blocker

* Amlodipine and benazepril (Lotrel)
* Enalapril and felodipine (Lexxel)
* Trandolapril and verapamil (Tarka)

(3)  Combined Alpha and Beta Blockers

* Carvedilol (Coreg)
* Labetalol hydrochloride (Normodyne)

(4) Combination Therapies

* Atenolol and chlorthalidone (Tenoretic)
* Bisoprolol and hydrochlorothiazide (Ziac)
* Nadolol and bendroflumethiazide (Corzide)
* Propranolol and hydrochlorothiazide (Inderide)
* Timolol and hydrochlorothiazide (Timolide)

(5) Combination Therapy – ACE Inhibitor/Diuretic

* Benazepril and hydrochlorothiazide (Lotensin)
* Enalapril and hydrochlorothiazide (Vaseretic)
* Lisinopril and hydrochlorothiazide (Prinzide, Zestoretic)
* Moexipril and hydrochlorothiazide (Uniretic)
* Quinapril and hydrochlorothiazide (Accuretic)
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