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Harvard Medical School
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General Medical Questions
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Question : My last two blood pressure readings were over 150/95. My doctor plans to recheck it in 2 weeks. But I will likely need to go on medicine to lower it. How does a doctor choose what drug to start?
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The Trusted Source
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Howard LeWine, M.D.

Howard LeWine, M.D., is chief editor of Internet Publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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January 01, 2014
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High blood pressure is defined as a reading of 140/90 or greater. Recent guidelines suggest that for people that are age 60 or older, a blood pressure of 150/90 might be acceptable. So no matter what your age, if your pressure is still that high you are right. You will need medicine.

The choice of which medicine to pick initially is somewhat dependent on your race and kidney function.

If you are black and have normal kidney function, start with a low-dose, thiazide-type diuretic (such as chlorthalidone or hydrochlorothiazide) or a calcium channel blocker. Another option would be a pill that contains very low doses of both drug types.

If you are not black and have normal kidney function, start with a low dose of one of these drug types:

  • Angiotension-converting enzyme (ACE) inhibitor
  • Angiotensin receptor blocker (ARB)
  • Thiazide-type diuretic (such as chlorthalidone or hydrochlorothiazide
  • Calcium channel blocker
  • Or a pill that contains very low doses of two different drugs

If you have impaired kidney function, consider starting with a low dose of an angiotension converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). This is true independent of race. These types of drugs help protect the kidneys from further damage. But don’t use both an ACE inhibitor and ARB together.

Everyone with high blood pressure should lose weight, if necessary. Cut back on salt, eat a diet loaded with vegetables and keep physically active.

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