What is the best medication to take for Hypertension (Htn)?

From the Guidelines

For patients with hypertension, the best medication to take with diuretics is an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), as recommended by the 2024 ESC guidelines 1. These medications work synergistically with diuretics to control blood pressure, with diuretics removing excess fluid and ACE inhibitors or ARBs relaxing blood vessels. The recommended first-line BP-lowering medications include ACE inhibitors, ARBs, dihydropyridine calcium channel blockers (CCBs), and diuretics (thiazides and thiazide-like drugs) 1. A common starting dose for an ACE inhibitor like lisinopril would be 10mg once daily, which can be titrated up to 40mg daily if needed, while for an ARB like losartan, starting at 50mg daily and increasing to 100mg if necessary is typical. Key considerations when combining these medications include monitoring potassium levels, as both diuretics and ACE inhibitors/ARBs can affect potassium balance in opposite ways, potentially offsetting each other's effects on electrolytes. The 2024 ESC guidelines recommend combination BP-lowering treatment for most patients with confirmed hypertension as initial therapy, with preferred combinations being a RAS blocker (either an ACE inhibitor or an ARB) with a dihydropyridine CCB or diuretic 1. It is also recommended to use fixed-dose single-pill combination treatment for patients receiving combination BP-lowering treatment 1. Overall, the choice of medication should be individualized based on patient characteristics, comorbidities, and potential side effects, with the goal of achieving optimal blood pressure control and minimizing adverse effects. Some key points to consider when selecting a medication include:

• The patient's kidney function and potential need for renal protection
• The presence of comorbidities such as diabetes or heart failure
• The potential for drug interactions and side effects
• The importance of monitoring potassium levels and adjusting the medication regimen as needed.

From the FDA Drug Label

Many patients will require more than 1 drug to achieve blood pressure goals. Amlodipine besylate tablets may be used alone or in combination with other antihypertensive agents. Lisinopril tablets USP may be administered alone or with other antihypertensive agents

The best medication to take with diet for Hypertension (Htn) is not explicitly stated in the provided drug labels. However, Lisinopril and Amlodipine can be used alone or in combination with other antihypertensive agents to achieve blood pressure goals 2, 3.

• Key points:
  • Lisinopril and Amlodipine are both indicated for the treatment of Hypertension.
  • Many patients will require more than one drug to achieve blood pressure goals.
  • Both medications can be used alone or in combination with other antihypertensive agents. It is essential to consult with a healthcare professional to determine the best course of treatment for individual patients 2, 3, 2.

From the Research

Medications for Hypertension

The following medications are commonly used to treat hypertension:

• Thiazide or thiazide-like diuretics, such as hydrochlorothiazide or chlorthalidone 4
• Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, such as enalapril or candesartan 4
• Calcium channel blockers, such as amlodipine 4

First-Line Therapies

First-line therapies for hypertension include:

• Lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 4
• Thiazide or thiazide-like diuretics, which have been shown to reduce mortality, stroke, and coronary heart disease 5
• Angiotensin-converting enzyme inhibitors, which have been shown to reduce mortality, stroke, coronary heart disease, and total cardiovascular events 5
• Calcium channel blockers, which have been shown to reduce stroke and total cardiovascular events 5

Comparison of Medications

Comparisons of different medications for hypertension have shown:

• No difference in efficacy between angiotensin receptor blockers and angiotensin-converting enzyme inhibitors with regard to blood pressure and outcomes of all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease 6
• ACE inhibitors remain associated with cough and a very low risk of angioedema and fatalities, while overall withdrawal rates due to adverse events are lower with angiotensin receptor blockers than with ACE inhibitors 6
• Diuretics and calcium-blocking drugs are more effective in elderly patients at lowering systolic blood pressure, while beta-blockers are relatively ineffective and have more side effects 7
• No significant differences in the incidence of end-stage renal disease or a 50% or greater decrement in glomerular filtration rate between patients treated with chlorthalidone, amlodipine, or lisinopril 8