What are the treatment options for Hypertension (High Blood Pressure)?

From the Guidelines

Hypertension treatment should begin with first-line medications including ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics, as they have demonstrated the most effective reduction of BP and CVD events, according to the 2024 ESC guidelines 1.

Key Recommendations

• The recommended first-line treatments for hypertension include ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics, due to their proven effectiveness in reducing blood pressure and cardiovascular disease events 1.
• Combination therapy with a RAS blocker and a dihydropyridine CCB or diuretic is recommended for most patients with confirmed hypertension as initial therapy, with exceptions including patients aged ≥85 years, those with symptomatic orthostatic hypotension, moderate-to-severe frailty, or elevated BP with a concomitant indication for treatment 1.
• Fixed-dose single-pill combination treatment is recommended for patients receiving combination BP-lowering treatment, to improve adherence and simplify treatment regimens 1.

Treatment Approach

• If blood pressure is not controlled with a two-drug combination, increasing to a three-drug combination is recommended, usually a RAS blocker with a dihydropyridine CCB and a thiazide/thiazide-like diuretic, and preferably in a single-pill combination 1.
• If blood pressure is not controlled with a three-drug combination, adding spironolactone should be considered, or treatment with eplerenone instead of spironolactone, or the addition of a beta-blocker if not already indicated 1.

Important Considerations

• The choice of medication should be individualized based on patient characteristics, comorbidities, and potential side effects, with consideration of the patient's values, resource considerations, and cost-effectiveness 1.
• Regular monitoring of blood pressure and adherence to treatment is crucial for effective hypertension management, with home blood pressure measurements providing valuable data between office visits 1.

From the FDA Drug Label

Spironolactone tablets are indicated as add-on therapy for the treatment of hypertension, to lower blood pressure in patients who are not adequately controlled on other agents. Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure.

Hypertension Treatment Options:

• Spironolactone is used as add-on therapy for hypertension treatment, especially when patients are not adequately controlled on other agents 2.
• Lisinopril is indicated for primary treatment of hypertension in adult and pediatric patients 6 years of age and older 3. Key Considerations:
• Both drugs aim to lower blood pressure and reduce the risk of fatal and non-fatal cardiovascular events, such as strokes and myocardial infarctions.
• Comprehensive cardiovascular risk management, including lipid control, diabetes management, and lifestyle modifications, is essential for optimal treatment outcomes.

From the Research

Hypertension Treatment Overview

• Hypertension is defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg, affecting approximately 116 million adults in the US and more than 1 billion adults worldwide 4.
• First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 4, 5.

Lifestyle Modifications

• Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, have been shown to have preventive and antihypertensive effects 5.
• Other lifestyle interventions, including stress management and promotion of adequate sleep patterns, may also be beneficial in reducing blood pressure 5.

Pharmacologic Therapy

• First-line drug therapy for hypertension consists of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 4.
• The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk 4.
• Combination therapy with a calcium channel blocker and an angiotensin II type 1 receptor blocker has been shown to be effective in achieving superior blood pressure control compared to monotherapy 6, 7.
• Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have similar efficacy in reducing blood pressure, but angiotensin receptor blockers may have fewer adverse events 8.

Treatment Goals

• The goal of hypertension treatment is to achieve a blood pressure target of <130/80 mm Hg for adults <65 years and SBP <130 mm Hg in adults ≥65 years 4.
• Achieving this goal can reduce the risk of cardiovascular disease events by approximately 20% to 30% for every 10 mm Hg reduction in SBP 4.