What Are the Side Effects of Blood Pressure Tablets?

October 8, 2025 •

5 min read

Approximately 1 in 3 American adults have high blood pressure, and many rely on medication to manage it. However, patients often have questions about what are the side effects of blood pressure tablets, as they can range from mild discomfort to more serious complications. For most people, side effects are mild and may subside as the body adjusts.

Quick Summary

Blood pressure medications can cause a variety of side effects that differ significantly between drug classes. Common reactions include dizziness and fatigue, while specific issues like dry cough or swelling are tied to particular medication types. Effectively managing these adverse effects often involves dosage adjustments and lifestyle modifications.

Key Points

Common Side Effects: Dizziness, fatigue, and headache are frequent across many blood pressure medications as the body adjusts to lower pressure.
Drug-Specific Reactions: Each class of medication, such as diuretics or ACE inhibitors, carries a distinct set of potential side effects, including cough, swelling, or electrolyte imbalance.
Temporary Adjustment: Mild side effects often improve or disappear within a few weeks as your body gets used to the new medication.
Manage with Your Doctor: Never stop taking your medication without consulting a healthcare provider, who can adjust your dosage or switch to a different drug to mitigate issues.
Know Emergency Signs: Serious side effects, like angioedema (face swelling) or severe chest pain, are rare but require immediate medical attention.

Managing high blood pressure (hypertension) is crucial for preventing heart attacks, strokes, and other serious health issues. While medication is a cornerstone of this treatment, it's important for patients to be aware of potential side effects. These reactions are not universal; their type and severity can vary widely depending on the specific class of medication prescribed. Understanding these differences and knowing how to respond is a key part of successful long-term management.

Common Side Effects Across All Medications

Several side effects are common to many different types of blood pressure medication, primarily because they are related to the general mechanism of lowering blood pressure. When blood pressure drops, the body can react with these common symptoms:

Dizziness or lightheadedness: This is one of the most frequent side effects, especially when standing up quickly from a sitting or lying position. This happens because blood flow to the head is reduced temporarily.
Fatigue or low energy: Many patients report feeling unusually tired or weak, particularly when first starting medication. This can be a result of the heart beating more slowly and less forcefully.
Headaches: Mild headaches are a common occurrence as the body's blood vessels adjust to a lower pressure.
Sexual dysfunction: Issues like erectile dysfunction are reported across several classes of blood pressure drugs and can impact a patient's quality of life.

Side Effects by Drug Class

Different types of blood pressure tablets target the cardiovascular system in unique ways, leading to specific side effect profiles. Here is a breakdown of common reactions associated with some of the most frequently prescribed classes.

Diuretics (Water Pills)

Diuretics help the body eliminate excess sodium and water, which reduces blood volume and lowers blood pressure.

Increased urination: A natural and expected effect, though it can be inconvenient. Taking the medication in the morning can help avoid nighttime bathroom trips.
Electrolyte imbalances: By flushing out fluids, diuretics can also alter levels of essential electrolytes like potassium and sodium. This can lead to symptoms like muscle cramps, weakness, or confusion.
Dehydration and thirst: The increased urination can lead to dehydration, especially in hot weather or during exercise.

ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors block the production of a hormone that narrows blood vessels, allowing them to relax. Medications in this class end in '-pril', such as lisinopril.

Dry, hacking cough: Affecting about 5-20% of users, this is one of the most distinctive and bothersome side effects. It often resolves after discontinuing the medication.
Angioedema: A rare but serious side effect involving swelling of the face, lips, tongue, or throat, which is a medical emergency.
Hyperkalemia: A higher than normal level of potassium in the blood can occur, especially in patients with kidney problems.

Angiotensin II Receptor Blockers (ARBs)

Like ACE inhibitors, ARBs block the effects of a hormone that constricts blood vessels, but they do so through a different mechanism. This class includes drugs like losartan, ending in '-sartan'.

Dizziness and headache: These are some of the most reported side effects.
Angioedema: While still a rare possibility, the risk of this serious swelling is lower with ARBs compared to ACE inhibitors.
Hyperkalemia: Similar to ACE inhibitors, ARBs can also cause elevated potassium levels.

Beta-Blockers

Beta-blockers, such as metoprolol, decrease blood pressure by slowing the heart rate and reducing the force of each heartbeat.

Slow heart rate: The intended effect can sometimes become a problematic side effect, especially for individuals who already have a slow heart rate.
Fatigue and depression: These can be significant side effects, affecting mood and energy levels.
Cold hands and feet: By reducing blood flow to the extremities, beta-blockers can cause this sensation.
Asthma symptoms: Non-selective beta-blockers can cause bronchospasm and are generally avoided in patients with asthma.

Calcium Channel Blockers (CCBs)

CCBs relax and widen blood vessels by blocking the entry of calcium into muscle cells. Examples include amlodipine.

Swollen ankles: Peripheral edema, or swelling in the feet and ankles, is a common dose-dependent side effect, especially with dihydropyridine CCBs.
Headache and flushing: The widening of blood vessels can lead to these symptoms.
Constipation: This is a common side effect, particularly with non-dihydropyridine CCBs like verapamil.

Comparison of Side Effects by Drug Class


Side Effect	Diuretics	ACE Inhibitors	ARBs	Beta-Blockers	CCBs
Dizziness/Fatigue	Common	Common	Common	Common	Common
Cough	No	Common	Less common	No	No
Swelling	No	Rare (Angioedema)	Rare (Angioedema)	Extremities	Ankles
Sexual Dysfunction	Possible	Possible	Possible	Possible	Possible
Electrolyte Imbalance	Yes	Yes (Hyperkalemia)	Yes (Hyperkalemia)	No	No
GI Issues	Constipation/diarrhea	Upset stomach	Upset stomach	Constipation	Constipation

Managing and Responding to Side Effects

It's crucial to work with your healthcare provider to manage any side effects. Here are some strategies:

Give it time: Many side effects, such as initial dizziness or fatigue, may diminish as your body adjusts to the medication. Give it a few weeks before deciding to stop.
Adjust dosage or timing: Your doctor may suggest lowering the dose or taking the medication at a different time of day. For example, taking a diuretic in the morning helps with frequent urination, while a drug that causes drowsiness might be taken at night.
Switch medications: If side effects persist or are intolerable, your doctor can switch you to a different medication, potentially from another drug class with a better-tolerated profile. For instance, a patient with a chronic cough on an ACE inhibitor can be switched to an ARB.
Lifestyle changes: Making small lifestyle adjustments can help. For example, standing up slowly can prevent dizziness. Staying hydrated can help with side effects from diuretics.
Report severe symptoms immediately: Certain side effects require immediate medical attention. These include severe swelling of the face or tongue (angioedema), difficulty breathing, severe chest pain, or fainting.

Conclusion

While blood pressure medications are essential for managing hypertension, they are not without potential side effects. These can range from common, mild symptoms like dizziness and fatigue to more specific issues tied to individual drug classes. By having an open and continuous dialogue with your healthcare provider, you can effectively manage these side effects, ensuring the treatment remains both effective and tolerable. Do not stop taking your medication without consulting your doctor, as this can lead to a dangerous spike in blood pressure. Many options and strategies exist to find a treatment that works for you with minimal discomfort. For additional information on specific medications, you can consult reliable sources like MedlinePlus.

MedlinePlus: High Blood Pressure Medications

Frequently Asked Questions

Fatigue is a very common side effect of many blood pressure medications, particularly beta-blockers, which slow down your heart rate and reduce the force of your heartbeat. As your body adjusts to the lower blood pressure and heart rate, this feeling often subsides over time.

Yes, a dry, hacking cough is a well-known side effect of ACE inhibitors, a class of blood pressure drugs. This cough is persistent and typically resolves after stopping the medication. If you experience this, your doctor can switch you to an alternative, like an ARB.

Swelling in the ankles and feet, known as peripheral edema, is a common side effect of calcium channel blockers. It is caused by the dilation of your blood vessels and is generally not a sign of heart failure. Your doctor may adjust your dosage or medication to help manage this.

Dizziness, especially when standing up, is a frequent side effect. To manage this, stand up slowly after sitting or lying down. If the dizziness is severe or persistent, inform your doctor, as they may suggest adjusting your dosage or the timing of your medication.

No, you should never stop your medication abruptly without consulting your doctor. Abruptly stopping can cause a dangerous rebound effect, leading to a sudden and severe spike in blood pressure. Always work with your healthcare provider to find a solution, which might involve a dosage change or a different medication.

Yes, lifestyle modifications can help mitigate some side effects. Staying properly hydrated can ease issues from diuretics, while incorporating relaxation techniques or exercise (if approved by your doctor) can help manage overall symptoms.

While rare, serious side effects include angioedema (swelling of the face, lips, or tongue), severe chest pain, or difficulty breathing. If you experience these, seek immediate emergency medical care. Your medication package insert provides specific warnings.