Hydrochlorothiazide alternatives: what to try if HCTZ isn’t working

Hydrochlorothiazide (HCTZ) is a common diuretic people take for high blood pressure. It works by helping the body get rid of extra salt and water. But HCTZ isn’t perfect for everyone—some get side effects like low potassium, frequent urination, or not enough blood pressure drop. If that sounds familiar, here are clear, practical alternatives and what you should know about each.

Common drug alternatives and when doctors pick them

Chlorthalidone and indapamide – these are thiazide-type cousins of HCTZ. Many clinicians prefer chlorthalidone for longer, steadier blood pressure control. Indapamide can be easier on blood sugar in some people. If your provider says HCTZ isn’t cutting it, they may switch you to one of these.

ACE inhibitors (example: lisinopril) – these relax blood vessels and lower pressure. Good choice if you also have diabetes or chronic kidney disease. Watch for cough or rare swelling of the face; check potassium and kidney function after starting.

ARBs (example: losartan) – similar to ACE inhibitors but less likely to cause cough. Often used when ACE inhibitors aren’t tolerated. They also protect kidneys in diabetes.

Calcium channel blockers (example: amlodipine) – these lower pressure by relaxing muscle in the arteries. They’re great for older adults and are often paired with other drugs. Side effects can include swelling of the ankles or headaches.

Beta blockers (example: metoprolol) – useful if you also have heart disease or rapid heart rate. Not always the first pick for simple high blood pressure, but helpful in certain situations.

Spironolactone – a potassium-sparing option used for resistant high blood pressure. It’s effective, but needs monitoring for high potassium and hormone-related side effects in some people.

Practical tips, monitoring, and lifestyle fixes

Combination pills – many meds work better together. If one drug isn’t enough, your doctor might prescribe a combo pill to simplify dosing and boost results.

Check labs – when you switch or start medicines, ask for blood tests: potassium, sodium, and kidney function. That helps catch problems early.

Lifestyle matters – salt reduction, regular walking, losing even a few kilos, cutting back on alcohol, and managing sleep can lower blood pressure and reduce the need for extra drugs. These steps work alongside medicines, not instead of them, unless your doctor says so.

How to talk to your doctor: say what side effects you have, how often your blood pressure spikes, and any other meds you take. Ask what monitoring is needed and how long before you’ll see benefits. If you want an evidence-based switch, mention chlorthalidone—many clinicians will discuss the pros and cons.

Want help picking the right option? Your pharmacist or primary care doctor can walk through choices, dosing, and monitoring. Safe changes are planned, checked, and adjusted—not rushed.