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Occasionally, drugs from the above groups may not be sufficient or suitable for treating an individual case of high blood pressure. Two other drugs are sometimes used: hydralazine or methyldopa.

Hydralazine is a vasodilator that lowers blood pressure by relaxing arteries and increasing their diameter. When used to treat hypertension, it is usually combined with a beta-blocker and thiazide diuretic to stop the heart rate and cardiac output from increasing and to avoid fluid retention. It may cause a very rapid drop in blood pressure.

Methyldopa used to be the most popular drug for treating high blood pressure, and may still be taken by elderly patients who started on it many years ago. It lowers blood pressure by acting on the brain to trigger nerve actions that reduce heart output, urine production and arteriolar constriction. Methyldopa is often used together with a diuretic. It may cause a rapid fall in blood pressure, especially in the elderly.

Your doctor may also suggest taking low-dose aspirin or taking drugs to lower blood cholesterol levels if necessary.