From the Guidelines
A blood pressure of 168/90 mmHg is considered stage 2 hypertension and requires prompt treatment with a target blood pressure of less than 130/80 mmHg. The initial approach should include both lifestyle modifications and medication therapy. Lifestyle changes include reducing sodium intake to less than 2,300 mg daily, adopting the DASH diet rich in fruits and vegetables, regular physical activity (150 minutes of moderate exercise weekly), limiting alcohol consumption, maintaining healthy weight, and smoking cessation.
Key Lifestyle Modifications
- Reducing sodium intake to less than 2,300 mg daily
- Adopting the DASH diet rich in fruits and vegetables
- Regular physical activity (150 minutes of moderate exercise weekly)
- Limiting alcohol consumption
- Maintaining healthy weight
- Smoking cessation For medication, a combination therapy is typically recommended, with RAS blockers, beta-blockers, and mineralocorticoid receptor antagonists being effective in improving clinical outcome 1. First-line options include a calcium channel blocker like amlodipine (5-10 mg daily) combined with either an ACE inhibitor like lisinopril (10-40 mg daily) or an angiotensin receptor blocker like losartan (50-100 mg daily). Alternatively, a thiazide diuretic such as hydrochlorothiazide (12.5-25 mg daily) may be used in the combination.
Medication Options
- Calcium channel blocker (e.g., amlodipine) + ACE inhibitor (e.g., lisinopril)
- Calcium channel blocker (e.g., amlodipine) + angiotensin receptor blocker (e.g., losartan)
- Thiazide diuretic (e.g., hydrochlorothiazide) Blood pressure should be monitored regularly, with a target of below 130/80 mmHg, as treating hypertension has a major impact on reducing the risk of incident heart failure and heart failure hospitalization 1. Medication adherence is crucial, and doses may need adjustment based on response. These medications work by either relaxing blood vessels, reducing fluid volume, or decreasing the heart's workload, all of which help lower blood pressure and reduce the risk of serious complications like heart attack, stroke, and kidney damage.
From the FDA Drug Label
1 INDICATIONS & USAGE 1. 1 Hypertension Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure.
Many patients will require more than one drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)
The treatment for a blood pressure of 168/90 would be to lower the blood pressure.
- Amlodipine can be used to treat hypertension.
- The goal is to reduce the blood pressure to a target level, but the exact target level is not specified in the label and should be determined based on published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) 2.
- It is likely that more than one drug will be required to achieve the desired blood pressure goal.
From the Research
Treatment of Blood Pressure 168/90
The treatment of blood pressure 168/90 involves initiating antihypertensive drug treatment, as the systolic blood pressure is above 140 mmHg and the diastolic blood pressure is above 90 mmHg. According to 3, antihypertensive agents are very well tolerated, and lowering systolic blood pressure below 130 mmHg appears well tolerated.
Recommended Treatment
The recommended treatment for hypertension includes:
- Initiating antihypertensive drug treatment when systolic blood pressure is at least 140 or diastolic blood pressure is at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk 3
- Achieving systolic blood pressure levels below 140 mmHg in all hypertensive patients, including the elderly, and values below 130 mmHg in patients having diabetes and high/very-high-risk patients 3
- Using a fixed combination of a drug that blocks the renin-angiotensin-aldosterone system and a calcium antagonist or a diuretic as first-choice therapy in the majority of hypertensive patients 4
Combination Therapy
Combination therapy is often required to achieve blood pressure goals, and the selection of a specific combination drug regimen depends on various factors. According to 5, combination treatment with either a calcium channel blocker and an ACE inhibitor or a beta-blocker and a diuretic is effective in achieving blood pressure control and produces similar outcomes in hypertensive patients with coronary artery disease.
Options for Combination Therapy
Options for combination therapy include:
- An ACE inhibitor/calcium channel blocker combination, which has been shown to be effective in preventing myocardial infarction and total mortality 4
- A beta-blocker/diuretic combination, which is also effective in achieving blood pressure control 5
- A renin-angiotensin-aldosterone system inhibitor with a diuretic or with a calcium channel blocker, which has been shown to be effective in different populations 6
Choosing the Best Combination Therapy
The choice of the best combination therapy is still debated, and current guidelines recommend different combinations. According to 6, the combination of a renin-angiotensin-aldosterone system inhibitor with a calcium channel blocker demonstrated the best efficacy in reducing cardiovascular endpoint. However, the combination of a renin-angiotensin-aldosterone system inhibitor with a diuretic has shown beneficial results in particular subgroups of patients, such as patients with heart failure or with African American origin.