From the Guidelines
Hypertension should be treated with a combination of lifestyle modifications and medication, with the goal of reducing blood pressure to below 130/80 mmHg, as recommended by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. To achieve this, patients should start by adopting a heart-healthy diet low in sodium, rich in fruits, vegetables, whole grains, and lean proteins.
- Regular physical activity, such as at least 150 minutes of moderate exercise weekly,
- Weight management,
- Limiting alcohol consumption, and
- Quitting smoking are essential lifestyle modifications. First-line medications include thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers.
- Treatment typically begins with a single medication at a low dose, increasing as needed to reach target blood pressure. Many patients require multiple medications for adequate control, and in cases of resistant hypertension,
- The addition of low-dose spironolactone to existing treatment,
- Further diuretic therapy,
- Bisoprolol, or
- Doxazosin may be considered, as outlined in the 2024 ESC guidelines 1. Regular blood pressure monitoring at home is also important, using a validated device and checking at the same time daily. In patients with resistant hypertension, catheter-based renal denervation may be considered if performed at a medium-to-high volume centre, and if the patient has BP that is uncontrolled despite a three BP-lowering drug combination, and who express a preference to undergo renal denervation after a shared risk-benefit discussion and multidisciplinary assessment 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. Many patients will require more than 1 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) 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. Many patients will require more than 1 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)
Treatment of Hypertension:
- Losartan and lisinopril are indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older.
- The goal is to lower blood pressure to reduce the risk of fatal and nonfatal cardiovascular events.
- Comprehensive Management: Control of high blood pressure should be part of comprehensive cardiovascular risk management, including:
- Lipid control
- Diabetes management
- Antithrombotic therapy
- Smoking cessation
- Exercise
- Limited sodium intake
- Guidelines: For specific advice on goals and management, refer to 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 3.
From the Research
Treatment Options for Hypertension
- Lifestyle modification is the first-line therapy for hypertension, including weight loss, healthy dietary pattern, 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 4, 5, 6
Medication Options
- Thiazide diuretics, such as chlortalidone or hydrochlorothiazide, are recommended as first-line treatment for hypertension 5, 6
- Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, such as enalapril or candesartan, are also recommended as first-line treatment 4, 6
- Calcium channel blockers, such as amlodipine, are recommended as first-line treatment for hypertension 4, 6
Lifestyle Modifications
- The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for patients with hypertension 6, 7
- Sodium restriction and potassium supplementation are also recommended 4, 7
- Regular exercise and moderate weight loss are associated with improvements in blood pressure 6, 7
- Moderation or elimination of alcohol consumption is also recommended 4, 7