If hydrochlorothiazide (HCTZ) gives you side effects or doesn’t control your blood pressure, you’ve got real options. Some drugs act like HCTZ but last longer, some protect your kidneys or heart better, and others avoid HCTZ’s common problems like higher blood sugar or uric acid. Below I’ll list the practical alternatives and explain when each one is a good choice.
Chlorthalidone — A thiazide-like diuretic often preferred over HCTZ because it works longer and may lower cardiovascular risk more. Expect stronger blood pressure effects and a higher chance of low potassium, so labs are needed.
Indapamide — Another thiazide-like option that’s gentler on blood sugar and cholesterol for some people. It’s a good swap if metabolic side effects from HCTZ are a worry.
Loop diuretics (furosemide, bumetanide) — These aren’t first-line for routine high blood pressure but are better for fluid overload (heart failure, severe edema). They act faster and are stronger than thiazides.
ACE inhibitors (lisinopril, enalapril) and ARBs (losartan, valsartan) — These drugs lower blood pressure and protect kidneys, especially if you have diabetes or proteinuria. ACE inhibitors can cause a dry cough in some; ARBs are an alternative if cough appears.
Calcium channel blockers (amlodipine, diltiazem) — Often used alone or with a diuretic. They’re effective, well tolerated, and don’t raise blood sugar or uric acid.
Beta-blockers (metoprolol, atenolol) — Useful when there’s another reason to use them (heart disease, arrhythmia). Less favored as a first choice just for blood pressure in older adults.
Spironolactone/eplerenone — Aldosterone blockers that help resistant hypertension (when three drugs fail). They save potassium rather than lowering it, so watch for high potassium and avoid if you have severe kidney disease.
Which one fits you depends on other health issues: kidney disease, diabetes, gout, or heart failure change the best choice. Before switching, doctors check blood pressure, electrolytes (sodium, potassium), and kidney function (creatinine). If you’re on HCTZ because of swelling from heart failure, a loop diuretic might be better. If you have diabetes or protein in the urine, ACE inhibitors or ARBs are often preferred.
Watch for these common trade-offs: thiazide-like drugs can lower potassium; spironolactone can raise it. ACE inhibitors risk cough; chlorthalidone can increase uric acid. Simple lifestyle moves—cutting salt, losing weight, moving more—make any medicine work better and sometimes let you use a lower dose.
Don’t stop or swap medicines on your own. Talk with your doctor about goals, side effects, and testing timelines. A careful switch and a few lab checks will keep you safer and more likely to get the blood pressure control you need.
