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Many people with kidney disease also have high blood pressure which will need treating with medicines called antihypertensives. Although most high blood pressure does not cause symptoms it is important that your blood pressure is controlled to prevent more damage to your kidneys and to prevent further complications such as a stroke or heart attack. 

There are lots of different medicines used to control high blood pressure and many people need more than one to keep their blood pressure at a suitable level. Your renal team will have a discussion with you to find the best medicines for you.  Here is some information about the different types. 

Beta blockers

Eg Bisoprolol, Carvedilol, Atenolol

These reduce blood pressure by slowing down the heart and are also used for other heart conditions.  They may not be suitable for you if you do a lot of sport or have asthma or other lung conditions.

The main side effects with these are tiredness, cold hands and feet and difficulties sleeping or having nightmares. 

ACE inhibitors

Eg Ramipril, Enalapril, Perindopril, Captopril

These relax and widen your blood vessels which lowers your blood pressure.

In some people these cause a dry, tickly cough which is not serious but you should tell your Renal Team so another medicine can be used instead.

The main side effect is feeling dizzy especially when first started. If this is the case take it at bedtime. Other side effects include headaches and diarrhoea.

These are not safe for pregnancy women to take. 

ARBs

Eg Losartan, Candesartan, Irbesartan, Valsartan

Like ACE inhibitors these widen and relax your blood vessels to lower your blood pressure.

The main side effects are feeling dizzy, headaches, diarrhoea and joint pain.

Rarely, some people can get allergic reactions to angiotensin antagonists. This may include itching, a rash or swelling of the lips and face. If this happens you should stop taking your tablets and speak to your doctor.

These are not safe for pregnancy women to take. 

Calcium channel blockers

Eg, Amlodipine, Felodipine, Lercanidipine, Nifedipine, Diltiazem, Verapamil

These reduce your blood pressure by widening your blood vessels

You should avoid drinking grapefruit juice whilst taking some of these as it may increase your risk of side effects.

The main side effects of these are swollen ankles (especially with Amlodipine), headaches and constipation. 

Diuretics

Eg Furosemide, Bumetanide, Spironolactone, Indapamide, Bendroflumethiazide

These are also known as water tablets as they work by removing extra fluid from your body by making you pass more urine.

These should be taken in the morning and at lunch time if prescribed these twice a day.

The main side effects of these are dehydration which can make you feel dizzy and increases or decreases in potassium. 

Alpha Blockers

Eg Doxazosin

This works by relaxing your blood vessels.

The main side effects with these are dizziness, headaches and swollen ankles, feet or fingers. 

Other blood pressure tablets

Eg Hydralazine, Moxonidine

There are sometimes used when your blood pressure is still high after a combination of other tablets.

Side effects can include fluid retention and tiredness 

Blood pressure medicines and Haemodialysis

Sometimes blood pressure medication can cause your blood pressure to fall too low during dialysis, causing problems. If this happens, the type of blood pressure medication you take may be changed or you may be advised take them at night. 

Sick Day Guidance

You may be asked to follow these rules when you are unwell with: 

1) Vomiting or diarrhoea

2) High temperature, fevers and sweating 

You should temporarily stop taking the following types of blood pressure medications to prevent you from becoming dehydrated. You should stay off these medicines until you are you are able to eat and drink normally for 24 to 48 hours.

• ACE inhibitors
• ARBs
• Diuretics

Other medicines that you may be asked to stop are

• Metformin (diabetes medicine)
• Tolvaptan
• SGLT2 inhibitors eg dapagliflozin, empagliflozin, canagliflozin

If you are unsure of whether to stop a medication, please contact your pharmacist, GP or specialist 

Looking after your medicines

You should store the tablets in their original packet in a cool, dry place out of the sight and reach of children.

Do not throw out any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacy. 

Please talk to your Renal Team if you have any other questions about your blood pressure medicines.

Last reviewed July 2023
Next review July 2026
Written by Charlotte Mallindine, Senior Renal Pharmacist

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The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.