Medically reviewed by Biljana Srbinovska, MPharm. Last reviewed July 2026.
Lisinopril is the most prescribed blood pressure medication in the United States, with roughly 76 million prescriptions a year, followed closely by amlodipine at about 69 million. Both sit in the top five of all US prescriptions of any kind. But popularity is not a recommendation. Which drug suits you depends on your age, kidney function, whether you have diabetes or heart failure, and whether you are or might become pregnant. Here is what is actually prescribed, what each class does, and what the 2025 guidelines changed.
The Most Prescribed Blood Pressure Drugs
| Medication | Class | Annual US prescriptions |
|---|---|---|
| Lisinopril | ACE inhibitor | About 76 million |
| Amlodipine | Calcium channel blocker | About 69 million |
| Metoprolol | Beta blocker | About 60 million |
| Losartan | ARB | About 56 million |
| Hydrochlorothiazide | Thiazide diuretic | About 32 million |
These figures come from prescription data for 2023, the most recent year published. Metoprolol’s high position is slightly misleading in a blood pressure context, since much of its use is for heart conditions rather than hypertension alone.
What Each Class Does
ACE inhibitors such as lisinopril block a hormone that narrows blood vessels, letting them relax.
ARBs such as losartan and valsartan block that same hormone at its receptor. They work similarly to ACE inhibitors but without the cough.
Calcium channel blockers such as amlodipine relax the muscle in artery walls.
Thiazide diuretics such as hydrochlorothiazide and chlorthalidone help the kidneys clear sodium and water, reducing the volume of fluid in circulation.
Beta blockers such as metoprolol slow the heart. Notably, they are not recommended as first-line treatment for uncomplicated high blood pressure, because they prevent stroke less effectively than other classes and are less well tolerated. They remain important for heart failure, after a heart attack, and for angina or arrhythmia.
What the 2025 Guideline Changed
The American Heart Association and American College of Cardiology published a new hypertension guideline in August 2025, replacing the 2017 version. The main points:
The categories did not change. Elevated is 120 to 129 systolic. Stage 1 is 130 to 139 over 80 to 89. Stage 2 is 140 over 90 or higher.
The target stayed at below 130/80, with encouragement to get closer to 120/80 where it can be achieved safely.
Stage 2 should now usually start with two medications, preferably combined in a single pill, rather than starting with one and adding later. Stage 1 may still start with a single drug. This is the most practical change for patients, and it explains why someone newly diagnosed may be handed a combination tablet straight away.
First-line classes are thiazide-type diuretics, long-acting calcium channel blockers, ACE inhibitors, and ARBs. Beta blockers are not on that list for uncomplicated hypertension.
The guideline also adopted new risk equations that removed race as a predictive factor, replacing the older model.
Side Effects Worth Knowing
ACE inhibitors: the dry cough. This is the most common reason people stop lisinopril, reported anywhere from 5% to 35% of users. It is a persistent tickly cough that does not respond to cough medicine. The useful thing to know is that switching to an ARB usually resolves it completely while keeping the same type of benefit. If you have quietly stopped taking your blood pressure medication because of a cough, that is worth a conversation rather than abandonment. Rarely, ACE inhibitors cause angioedema, a swelling of the face, lips, or throat, which needs emergency care.
Amlodipine: ankle swelling. Affects roughly one in ten and is dose-related. Also flushing and headache.
Thiazide diuretics: potassium. They can lower potassium and sodium and raise uric acid and blood sugar, which is why periodic blood tests are part of treatment. Expect more trips to the bathroom, particularly at first.
Beta blockers: fatigue, a slower pulse, and cold hands and feet.
Pregnancy: An Important Warning
ACE inhibitors and ARBs carry an FDA boxed warning and must not be used in pregnancy, in any trimester. They can cause serious harm to a developing baby. If you take lisinopril, losartan, or a similar drug and become pregnant or are planning to, contact your prescriber promptly so treatment can be changed. Do not simply stop, since uncontrolled blood pressure in pregnancy is also dangerous.
Never Stop Abruptly
Stopping blood pressure medication suddenly can cause a rebound rise in pressure. With beta blockers specifically, abrupt withdrawal can trigger chest pain or worse. If you want to stop, whether because of side effects, cost, or because your readings have improved, do it with your prescriber’s plan rather than on your own.
Cost
These are among the cheapest prescriptions in medicine. Average cost per fill runs around $11 to $13, and discount pharmacy prices for lisinopril and amlodipine start at roughly $6 for a month’s supply. Combination pills are still usually under $10.
If cost is a barrier, say so to your prescriber, because within these classes there is almost always an inexpensive generic option.
Blood Pressure Medication FAQs
What is the most prescribed blood pressure medication?
Lisinopril, an ACE inhibitor, at roughly 76 million US prescriptions a year, followed by amlodipine at about 69 million. Both are in the top five of all prescriptions nationally.
Which blood pressure medicine is best?
There is no single best. Guidelines list thiazide diuretics, long-acting calcium channel blockers, ACE inhibitors, and ARBs as first-line, with the choice depending on your age, kidney function, diabetes, heart failure, and pregnancy status.
Why does lisinopril cause a cough?
ACE inhibitors affect a pathway that can trigger a persistent dry cough, reported in 5% to 35% of users. Switching to an ARB such as losartan usually resolves it while providing similar benefit.
Are beta blockers still used for high blood pressure?
Not as first-line for uncomplicated hypertension, because they prevent stroke less effectively than other classes. They remain important for heart failure, after a heart attack, and for angina or arrhythmia.
Can I take blood pressure medication while pregnant?
Not ACE inhibitors or ARBs, which carry a boxed warning and are contraindicated in all trimesters. Contact your prescriber promptly to change treatment rather than stopping on your own.
Why was I started on two medications at once?
The 2025 guideline recommends that stage 2 hypertension, meaning 140/90 or above, usually begins with two drugs, ideally combined in one pill, rather than adding a second later.
