From the Guidelines
The primary medications used to treat hypertension are ACE inhibitors, ARBs, dihydropyridine CCBs, and thiazide or thiazide-like diuretics, which can be used alone or in combination as first-line BP-lowering medications. These classes of medications are recommended due to their effectiveness in reducing blood pressure and improving outcomes, as supported by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. The major classes of medications are:
- ACE Inhibitors (e.g., lisinopril, enalapril):
- Mechanism: Block angiotensin-converting enzyme
- Typical dose: 10-40 mg daily
- Benefits: Reduce blood pressure, protect kidneys
- Angiotensin Receptor Blockers (ARBs) (e.g., losartan, valsartan):
- Mechanism: Block angiotensin II receptors
- Typical dose: 50-100 mg daily
- Benefits: Similar to ACE inhibitors, fewer side effects
- Calcium Channel Blockers (e.g., amlodipine, nifedipine):
- Mechanism: Reduce calcium influx in vascular smooth muscle
- Typical dose: 5-10 mg daily
- Benefits: Effective for isolated systolic hypertension
- Thiazide Diuretics (e.g., hydrochlorothiazide):
- Mechanism: Increase sodium and water excretion
- Typical dose: 12.5-25 mg daily
- Benefits: Low-cost, effective for most patients For patients with resistant hypertension, the addition of spironolactone, eplerenone, or beta-blockers may be considered, with vasodilating beta-blockers (e.g., labetalol, carvedilol, or nebivolol) being preferred when a beta-blocker is chosen 1. It is essential to note that the choice of medication should be individualized based on the patient's specific needs and medical history, and that combination therapy may be necessary to achieve adequate blood pressure control. Regular monitoring of blood pressure, renal function, and electrolytes is crucial to adjust dosages as needed and minimize side effects. In general, the use of diuretics, such as thiazide diuretics, is also supported by other guidelines, including the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 2.
From the FDA Drug Label
Numerous antihypertensive drugs, from a wide variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits The medications used to treat hypertension include:
- Aliskiren 3
- Lisinopril 4 These medications are part of a comprehensive cardiovascular risk management plan, which may also include lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than 1 drug to achieve blood pressure goals.
From the Research
Medications Used to Treat Hypertension
The following medications are used to treat hypertension:
- Thiazide or thiazide-like diuretics, such as hydrochlorothiazide or chlorthalidone 5, 6, 7, 8
- Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, such as enalapril or candesartan 5
- Calcium channel blockers, such as amlodipine 5
- Loop diuretics, such as furosemide, may be useful in certain circumstances, such as hypertension related to chronic kidney disease (CKD) 6, 7
- Potassium-sparing diuretics, such as amiloride or triamterene, may be used in combination with thiazide diuretics 8
- Aldosterone antagonists, such as eplerenone, may be used in certain circumstances, such as heart failure 7
First-Line Therapies
First-line therapies for hypertension include:
- Thiazide or thiazide-like diuretics, such as chlorthalidone or hydrochlorothiazide 5, 6, 8
- Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, such as enalapril or candesartan 5
- Calcium channel blockers, such as amlodipine 5
Considerations for Treatment
When selecting a medication for hypertension, considerations include:
- The level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk 5
- The potential for adverse effects, such as hyperglycemia and diabetes, which can be associated with thiazide diuretics 8
- The need for combination therapy, which may be necessary in some cases to achieve adequate blood pressure control 5, 8