There are a variety of high blood pressure medications

Q. If you have high blood pressure, aren't you better off just taking old-fashioned water pills instead of all these fancy drugs?

Water pills (aka diuretics) are the oldest and best studied of the drugs used to treat high blood pressure (aka hypertension). Diuretics help the kidneys flush extra water and salt from your body and decrease blood volume to lower pressure.

There are three types of diuretics: thiazide, loop and potassium-sparing. They work in different parts of your kidneys.

In the years since water pills were the drugs of choice for hypertension, the pharmaceutical companies have developed a variety of medicines to keep your pressure in check in ways that are different from the mechanism of diuretics. These include beta-blockers, ACE inhibitors, ARBS, calcium channel blockers, vasodilators, alpha blockers and renin inhibitors.

So, what should you take if you have high blood pressure? Ask your doctor.

Treating high blood pressure can be tricky, because patients react differently to anti-hypertensive drugs. Sometimes, doctors have to find the right combination of several drugs to lower blood pressure.

Now we get into the issue of money. Diuretics are cheap. The newer anti-hypertensives are comparatively expensive.

One significant study found that generic diuretic pills that cost pennies a day worked better for patients with high blood pressure than newer drugs that could be as much as 20 times as expensive. Because hypertension affects tens of millions of Americans, this finding had the potential to save the healthcare system billions of dollars.

But, following the release of the findings, the percentage of patients taking the cheaper diuretics barely increased.

“In the current healthcare system,” Pauline W. Chen, MD, a columnist, wrote in The New York Times, “clinicians are rewarded for doing and ordering more. Pharmaceutical and medical device firms reap fortunes from physicians' orders, and a single change could cost them billions. Studies that endorse anything less than another expensive procedure or a newer and more expensive medication or the latest device are often destined for failure or a protracted struggle against drug and device companies that are willing to put up a costly fight.”

A large group of medical experts known as the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that most people try thiazide diuretics as the first choice to treat high blood pressure. If diuretics by themselves don't lower your blood pressure, your doctor may recommend adding newer medications.

The following are some blood-pressure treatment recommendations from the National Heart, Lung and Blood Institute of the National Institutes of Health:

• If you need to begin drug treatment, you should definitely try a diuretic first.

• Beta blockers are another option to begin treatment, especially if you're younger than age 60 and do not have diabetes or peripheral artery disease.

• If you need multiple drugs to control your blood pressure, make one a diuretic.

• If you have angina (chest pain from heart disease), you may need to take a calcium channel blocker. It should be used along with a diuretic.

Diuretics are generally safe, but do have side effects. The most common side effect is increased urination. For most people, this side effect improves within a few weeks of taking a diuretic.

People who take diuretics may also have too much potassium in their blood if they take a potassium-sparing diuretic, or too little potassium in their blood if they take a thiazide diuretic.