If your blood pressure is higher than the “pre-hypertension” range— that is, if it is classified as either Stage 1 or 2 hypertension—your doctor will likely recommend not only these lifestyle changes but will also prescribe medication treatment. Some of the medications used to treat other heart-related problems may also be prescribed just for high blood pressure.

But several recent studies have demonstrated that thiazide diuretics, inexpensive medications that have been around for a long time, are as good as newer and more expensive drugs for lowering blood pressure. Thiazide diuretics, such as hydrochlorothiazide (sometimes called HCTZ), can cause you to urinate more.

Their effect on blood pressure occurs after being on the drug for a short time. A recent clinical study of more than 30,000 people with hypertension showed that thiazide diuretics were as effective (and less expensive) for protecting against heart problems, stroke, and narrowing of the arteries than ACE inhibitors or calcium channel-blockers.

These findings received a lot of media attention, but another new study showed that ACE inhibitors work better than diuretics at protecting against future heart problems and death. So there remains some controversy about the best approach. New studies comparing antihypertension medications are coming out all the time.

In a recent clinical study involving people with long-standing hypertension, a relatively new medication called an angiotensin receptor-blocker (ARB) lowered blood pressure just as well as beta-blockers. Furthermore, ARBs prevented even more heart attacks, strokes, and deaths than the beta-blockers over the long term.

These benefits were especially strong for people with diabetes. Conflicting studies can be confusing for physicians and their patients. Even as doctors debate the best approach, you should know that there remains strong agreement that the control of blood pressure is what is most important.

For now, the Joint National Committee on High Blood Pressure recommends that patients who need medication for high blood pressure first be considered for a thiazide diuretic and then an ACE inhibitor, ARB, beta-blocker, or calcium channel–blocker, or a combination of these drugs.

The committee also recommends that patients with Stage 2 hypertension be started on two medications from the beginning, preferably a thiazide diuretic in combination with another class of blood pressure–lowering medication. To make this clear, here’s what you really need to know:

• There are proven medications for lowering your blood pressure, and precisely which medication is right for you is something you need to explore with your doctor.

• If you’re taking medication but it fails to reduce your blood pressure enough to reach your target levels, talk to your doctor. Your doctor should increase the dose or add another medication. Sometimes, taking more than one type of medication is the only way to bring your blood pressure down to target range. If your blood pressure is still too high despite taking medication, don’t increase the dose without talking to your doctor.

• If you are taking more than one prescription, over-the-counter, or alternative medicine at a time, be sure to ask your doctor or pharmacist about potential negative interactions. It’s your responsibility to make sure your doctors are aware of all the medicines you take. You should have a list that you bring to each visit.

Like all medications, those used to treat high blood pressure have potential side effects. Most of these side effects are specific to the particular family of medication you may be taking. One uncommon side effect that all of these medications can cause is “hypotension,” having a blood pressure that is too low.

Older adults may be more prone to periods of hypotension, especially after rising quickly or after eating a meal. Symptoms typically involve feeling dizzy or light-headed for a brief period of time. These symptoms can be reduced by starting the medication at a very low dose and gradually increasing it until it reaches an effective level. You should talk with your doctor if you feel dizzy or light-headed.

Ironically, the most common reason high blood pressure medications don’t work is that patients don’t take them. In a sense, this isn’t surprising. High blood pressure has few symptoms; it’s easy for people to forget to take their medication. But make no mistake: high blood pressure is dangerous; not taking your medication is inviting trouble.

If you’re taking your medication as prescribed and your blood pressure still hasn’t changed appreciably, or if the side effects of the medication make you want to stop taking it, you should talk to your doctor about switching to a different medication. That raises an important question: Can you ever stop taking hypertension medication?

Yes, it’s entirely possible. If your blood pressure has been under control for at least one year, your doctor may decide it is possible to reduce the dose you’re taking—in time, perhaps, to zero. But this should be done slowly and gradually. This “step-down” therapy is most successful in people who have made and maintained the lifestyle changes that can bring high blood pressure under control.

When you reach this point you may want to talk to your doctor about working together to see if you can reduce or eliminate your medications. If you’re able to work with your doctor to stop your medications, you will still need to monitor your blood pressure carefully, because it can rise again, even months or years later—especially if you abandon those lifestyle changes.