What is the most prescribed drug for hypertension?

October 15, 2025 •

4 min read

According to 2023 data, lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, was ranked as one of the most commonly prescribed drugs in the United States, placing it as a strong candidate for what is the most prescribed drug for hypertension. While lisinopril consistently leads in prescription volume, other medications like amlodipine and hydrochlorothiazide are also extremely common treatments for high blood pressure. The specific medication a doctor prescribes is tailored to a patient’s individual health needs.

Quick Summary

Lisinopril is frequently cited as the most prescribed drug for high blood pressure, but other common medications include amlodipine and hydrochlorothiazide. These drugs belong to different classes, such as ACE inhibitors, calcium channel blockers, and diuretics, which lower blood pressure through various mechanisms. The ideal treatment is determined by individual patient factors like comorbidities, age, and race.

Key Points

Lisinopril is a top contender: The ACE inhibitor lisinopril is consistently ranked as one of the most prescribed drugs for hypertension due to its effectiveness, low cost, and tolerability.
Multiple drugs lead the market: Besides lisinopril, other commonly prescribed medications include amlodipine (a calcium channel blocker) and hydrochlorothiazide (a diuretic), each with a different mechanism of action.
Patient factors are critical: The choice of medication is tailored to the individual, considering comorbidities like diabetes or heart failure, age, ethnicity, and side-effect tolerance.
Lifestyle changes are essential: Medication is most effective when combined with healthy lifestyle habits, such as a low-sodium diet, regular exercise, and stress management.
Guidelines drive prescribing patterns: The use of different antihypertensive drugs is influenced by clinical practice guidelines from major medical organizations, as well as cost and generic availability.
Combination therapy is common: Many patients require two or more medications to achieve optimal blood pressure control, and combination pills are frequently used for convenience.

Lisinopril: A Top Contender for Hypertension

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that has consistently ranked as one of the most prescribed medications overall in the United States, solidifying its position as a primary drug for managing high blood pressure. ACE inhibitors work by blocking the production of angiotensin II, a potent hormone that causes blood vessels to constrict. By inhibiting this enzyme, lisinopril allows blood vessels to relax and widen, which in turn lowers blood pressure and reduces the workload on the heart. Its popularity is due to a combination of its proven effectiveness, good tolerability for most patients, and low cost as a widely available generic medication.

Other Commonly Prescribed Blood Pressure Medications

While lisinopril often takes the top spot, several other classes of medication are widely prescribed to manage hypertension, either alone or in combination therapy.

Calcium Channel Blockers (CCBs) Amlodipine (Norvasc) is a leading calcium channel blocker and is regularly listed among the most prescribed drugs in the country. CCBs work by preventing calcium from entering the muscle cells of the heart and blood vessels. This results in the relaxation of blood vessel walls and a reduced heart rate, lowering blood pressure. Amlodipine is particularly noted for its use as a first-choice medication, especially in certain patient populations.

Diuretics Often referred to as "water pills," diuretics are another highly common and effective first-line treatment for hypertension. Hydrochlorothiazide (HCTZ) is a prime example of a thiazide diuretic that helps the kidneys remove excess sodium and water from the body through urination. This reduces the overall blood volume, which decreases pressure on the artery walls. For decades, thiazide diuretics have been recommended as first-line therapy.

Angiotensin II Receptor Blockers (ARBs) ARBs, such as losartan (Cozaar), work in a similar pathway to ACE inhibitors but block the action of angiotensin II by preventing it from binding to receptors in the blood vessels. This provides an alternative for patients who cannot tolerate ACE inhibitors, particularly those who experience the dry cough side effect.

Beta-Blockers Metoprolol (Lopressor, Toprol XL) is a widely prescribed beta-blocker that works by blocking the effects of adrenaline. This causes the heart to beat more slowly and with less force, thereby lowering blood pressure. Metoprolol is also used to treat other heart conditions like angina and to improve survival rates after a heart attack.

Comparing Top Hypertension Medications


Medication (Generic Name)	Drug Class	Mechanism of Action	Common Side Effects	Key Use(s) Beyond HTN
Lisinopril	ACE Inhibitor	Blocks production of angiotensin II, relaxing blood vessels.	Dry cough, dizziness, fatigue, high potassium.	Heart failure, post-heart attack survival.
Amlodipine	Calcium Channel Blocker	Prevents calcium from entering cells, relaxing blood vessels and slowing heart rate.	Swelling (edema), dizziness, fatigue, nausea.	Angina, coronary artery disease.
Hydrochlorothiazide	Thiazide Diuretic	Increases urination to remove excess sodium and water, reducing blood volume.	Increased urination, low potassium, dizziness, thirst.	Edema (fluid retention).
Losartan	ARB	Blocks angiotensin II from binding to receptors, relaxing blood vessels.	Dizziness, high potassium, headache.	Reduce stroke risk in patients with enlarged heart.
Metoprolol	Beta-Blocker	Blocks adrenaline effects, slowing heart rate and force.	Fatigue, dizziness, reduced libido, cold hands/feet.	Angina, congestive heart failure, post-heart attack survival.

Factors Influencing Prescribing Decisions

The most prescribed drug is not a universal 'best' drug. Instead, the choice of medication is highly individualized, based on several key factors:

Patient Demographics: Research shows certain ethnic groups may respond differently to medications. For instance, calcium channel blockers or diuretics are often recommended as first-line therapy for Black adults.
Co-existing Health Conditions: A patient's other medical issues significantly impact the choice of medication. An ACE inhibitor might be preferred for a patient with diabetes to protect the kidneys, while a beta-blocker is appropriate for someone with a history of heart attack.
Cost and Accessibility: The availability and affordability of generic versions, as seen with lisinopril, can make certain medications more widely prescribed.
Side Effects: The patient's tolerance for a medication's side effects is crucial. If a patient develops a persistent dry cough from an ACE inhibitor, for example, a doctor might switch them to an ARB.
Guidelines: National and international guidelines from bodies like the American Heart Association (AHA) and American College of Cardiology (ACC) influence clinical practice by providing recommendations based on the latest research.

Lifestyle Changes and Combination Therapy

Medication is often used in combination with lifestyle modifications to effectively manage hypertension. These changes include a low-sodium diet, regular exercise, limiting alcohol intake, and managing stress. In many cases, blood pressure control requires a combination of two or more medications from different classes to achieve the target blood pressure. Combination pills that include a diuretic with an ACE inhibitor or ARB are also widely used for convenience and effectiveness. The specific medication regimen should always be discussed with a healthcare provider to ensure a safe and personalized treatment plan.

Conclusion

While lisinopril is frequently cited as the most prescribed drug for hypertension, it is one of several commonly used and effective options. Other popular choices include amlodipine, hydrochlorothiazide, and losartan, each belonging to different classes of medication with unique mechanisms of action. The best treatment is never a one-size-fits-all solution but rather a personalized strategy developed in consultation with a healthcare provider, taking into account individual health factors, potential side effects, and affordability. For comprehensive information on cardiovascular health, refer to resources from authoritative sources like the American Heart Association (AHA), which provides the latest guidelines on hypertension management.

Frequently Asked Questions

Thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), and calcium channel blockers are all considered first-line therapy options for high blood pressure. The specific choice depends on patient factors.

Lisinopril is an ACE inhibitor that blocks the body's production of angiotensin II, a hormone that narrows blood vessels. By doing this, it relaxes and widens the blood vessels, which lowers blood pressure and improves blood flow.

Yes, it is very common for a doctor to prescribe combination therapy with two or more different types of blood pressure medications, often to achieve better control. Some of these combinations are even available as a single pill.

The most common side effect is a dry, hacking cough. Other potential side effects include dizziness, fatigue, and elevated potassium levels.

Amlodipine, a calcium channel blocker, might be prescribed if a patient cannot tolerate the side effects of lisinopril (like the cough) or has specific co-existing conditions. For example, studies suggest calcium channel blockers can be effective first-choice options for Black adults.

Yes, generic medications are rigorously tested to ensure they contain the same active ingredients and are bioequivalent to their brand-name counterparts. Lisinopril is a generic medication, with brand names including Zestril and Prinivil.

Healthy lifestyle habits are crucial for managing blood pressure. These include maintaining a low-salt and healthy diet, getting regular physical activity, limiting alcohol, and not smoking.