From the Guidelines
The drug of choice for hypertension in non-diabetic adults is typically a thiazide diuretic, such as chlorthalidone, or a calcium-channel blocker, due to their efficacy and preference as first-line therapy. According to the 2017 American College of Cardiology/American Heart Association hypertension guideline 1, thiazide diuretics (especially chlorthalidone) and calcium-channel blockers are the preferred options for first-line therapy in most adults because of their efficacy.
Key Considerations
- Thiazide diuretics work by inhibiting sodium reabsorption in the distal convoluted tubule of the kidney, promoting sodium and water excretion, which reduces blood volume and subsequently lowers blood pressure.
- Calcium-channel blockers are also effective in lowering blood pressure by reducing the influx of calcium into vascular smooth muscle and cardiac muscle, thereby decreasing peripheral resistance and lowering blood pressure.
- For patients who cannot tolerate thiazides or who have specific comorbidities, alternative first-line options include angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
Treatment Approach
- Treatment should be initiated at a low dose and titrated upward as needed to achieve target blood pressure, generally below 130/80 mmHg.
- Lifestyle modifications, including sodium restriction, regular exercise, weight management, and limiting alcohol consumption, should accompany medication therapy.
- Regular monitoring of electrolytes, particularly potassium, is important when using diuretics.
- For patients with stage 2 hypertension, initiation of 2 antihypertensive agents from different classes is recommended when the average SBP and DBP are more than 20 and 10 mm Hg above target, respectively, as stated in the guideline 1.
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 drug of choice for hypertension in non-diabetic adults is not explicitly stated in the provided drug labels. Both losartan 2 and lisinopril 3 are indicated for the treatment of hypertension, but the labels do not provide a direct comparison or recommendation for one over the other in non-diabetic adults.
- Key points:
- Both drugs are used to lower blood pressure.
- Both drugs have similar indications for hypertension.
- The choice of drug may depend on individual patient factors and other considerations not specified in the labels.
From the Research
Treatment Options for Hypertension in Non-Diabetic Adults
The treatment of hypertension in non-diabetic adults involves several classes of drugs, including diuretics, β-adrenoceptor antagonists, ACE inhibitors, angiotensin II type 1 receptor antagonists, renin inhibitors, calcium channel blockers, and central sympatholytics 4.
First-Line Treatment
According to the study published in Prescrire international, the first-choice treatment for hypertension in non-diabetic adults without cardiovascular or renal disease should be a thiazide diuretic, such as chlortalidone or hydrochlorothiazide 5.
Alternative Options
Other studies suggest that ACE inhibitors, such as captopril, lisinopril, or ramipril, can be used as an alternative to thiazide diuretics when they are not available or cannot be used 5. However, a review published in the Journal of the American College of Cardiology found that angiotensin receptor blockers (ARBs) may be a better option than ACE inhibitors due to their similar efficacy and lower risk of adverse events 6.
Combination Therapy
Combination therapy, which involves the use of two or more antihypertensive agents, may be necessary to achieve blood pressure goals in some patients 4, 7, 8. The choice of combination therapy depends on various factors, including the patient's disease profile and the potential benefits and risks of each treatment option. Some studies suggest that combining a renin-angiotensin-aldosterone system (RAAS) inhibitor with a calcium channel blocker (CCB) may be more effective than combining a RAAS inhibitor with a diuretic in reducing cardiovascular events 8.
Key Points
- Thiazide diuretics, such as chlortalidone or hydrochlorothiazide, are recommended as first-line treatment for hypertension in non-diabetic adults without cardiovascular or renal disease 5.
- ACE inhibitors, such as captopril, lisinopril, or ramipril, can be used as an alternative to thiazide diuretics 5.
- ARBs may be a better option than ACE inhibitors due to their similar efficacy and lower risk of adverse events 6.
- Combination therapy may be necessary to achieve blood pressure goals in some patients 4, 7, 8.