What is the recommended treatment for a 20-year-old patient with hypertension (HTN)?

From the Guidelines

For a 20-year-old with hypertension, I strongly recommend initiating treatment with lifestyle modifications, including a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern, weight loss if indicated, moderation of alcohol intake, and increased physical activity, as outlined in the 2022 standards of medical care in diabetes 1. This approach is crucial because it not only lowers blood pressure but also enhances the effectiveness of antihypertensive medications, promotes metabolic and vascular health, and leads to few adverse effects. The lifestyle interventions should include reducing excess body weight through caloric restriction, restricting sodium intake to less than 2,300 mg/day, increasing consumption of fruits and vegetables (8–10 servings per day) and low-fat dairy products (2–3 servings per day), avoiding excessive alcohol consumption (no more than 2 servings per day in men and no more than 1 serving per day in women), and increasing activity levels. If blood pressure remains elevated despite lifestyle changes, pharmacological therapy should be considered, with first-line options including ACE inhibitors, ARBs, or calcium channel blockers, as suggested by the 2017 American College of Cardiology/American Heart Association hypertension guideline 1. Regular follow-up every 3-6 months is essential to monitor blood pressure control and medication side effects, with a target blood pressure of <130/80 mmHg. It's also important to investigate secondary causes of hypertension in this age group, including renal disease, endocrine disorders, coarctation of the aorta, and sleep apnea. Given the most recent and highest quality evidence, the focus should be on lifestyle modifications as the initial step in managing hypertension in a 20-year-old, with pharmacological intervention considered based on the response to lifestyle changes and the presence of other risk factors or complications.

From the FDA Drug Label

Losartan is indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older, to lower blood pressure. 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.

The recommended treatment for a 20-year-old with hypertension is to lower blood pressure using medications such as losartan 2 or lisinopril 3.

• Key considerations:
  • Control of high blood pressure should be part of comprehensive cardiovascular risk management.
  • Many patients will require more than one drug to achieve blood pressure goals.
  • The choice of therapy may be guided by the presence of other conditions, such as diabetes or hyperlipidemia.

From the Research

Treatment Recommendations for a 20-year-old with Hypertension

• The first-line therapy for hypertension is lifestyle modification, including weight loss, a healthy dietary pattern with low sodium and high potassium intake, physical activity, and moderation or elimination of alcohol consumption 4.
• The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk 4.
• 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, which should be titrated according to office and home blood pressure levels to achieve a target blood pressure of less than 130/80 mmHg 4, 5.
• Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, can also be effective in preventing and treating hypertension 6.
• The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to reduce blood pressure in adults with and without hypertension, with a greater reduction in systolic blood pressure seen in trials with a higher baseline blood pressure 7, 8.

Lifestyle Modifications

• Weight loss: recommended for individuals who are overweight or obese 4, 6.
• Healthy dietary pattern: emphasis on low sodium and high potassium intake, as well as a diet rich in fruits, vegetables, and whole grains 4, 6.
• Physical activity: regular exercise, such as walking or other aerobic activities, can help lower blood pressure 4, 6.
• Moderation or elimination of alcohol consumption: recommended to reduce blood pressure and cardiovascular risk 4.

Medication Therapy

• Thiazide or thiazide-like diuretics: first-line medication for hypertension, effective in reducing blood pressure and cardiovascular risk 4, 5.
• Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers: first-line medication for hypertension, effective in reducing blood pressure and cardiovascular risk 4, 5.
• Calcium channel blockers: first-line medication for hypertension, effective in reducing blood pressure and cardiovascular risk 4, 5.