What are the treatment options for Hypertension (High Blood Pressure)?

From the Guidelines

Hypertension treatment should typically begin with a combination of two medications, preferably a RAS blocker (either an ACE inhibitor or an ARB) with a dihydropyridine CCB or diuretic, as recommended by the 2024 ESC guidelines 1. This approach is supported by the most recent evidence, which suggests that combination therapy is more effective in reducing blood pressure and cardiovascular disease events compared to monotherapy. The recommended first-line treatments include ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics, which have demonstrated the most effective reduction of BP and CVD events 1. Some key points to consider when treating hypertension include:

• Using a fixed-dose single-pill combination treatment to improve adherence 1
• Increasing to a three-drug combination if blood pressure is not controlled with a two-drug combination, usually a RAS blocker with a dihydropyridine CCB and a thiazide/thiazide-like diuretic 1
• Considering the addition of spironolactone if blood pressure is not controlled with a three-drug combination 1
• Avoiding the combination of two RAS blockers (ACE inhibitor and an ARB) due to the increased risk of adverse effects 1 The goal of treatment is to achieve a blood pressure below 130/80 mmHg for most adults, though targets may vary based on age and comorbidities. Regular monitoring, including home blood pressure measurements, is essential to adjust treatment as needed and maintain steady blood pressure control.

From the FDA Drug Label

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

Hypertension Treatment:

• Lisinopril and losartan are both indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older.
• The goal of treatment is to lower blood pressure, which reduces the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions 2 3.
• Comprehensive cardiovascular risk management should include, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake.
• Many patients will require more than one drug to achieve blood pressure goals.

From the Research

Hypertension Treatment Overview

• Hypertension is defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg, affecting approximately 116 million adults in the US and more than 1 billion adults worldwide 4.
• Hypertension is associated with increased risk of cardiovascular disease (CVD) events and death.

Lifestyle Modifications

• First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern that includes low sodium and high potassium intake, physical activity, and moderation or elimination of alcohol consumption 4, 5, 6.
• The Dietary Approaches to Stop Hypertension (DASH) diet, sodium restriction, regular exercise, and moderate weight loss are associated with improvements in blood pressure 7, 5, 6.
• Increased physical activity helps lower both systolic and diastolic blood pressure, and an inverse relationship exists between blood pressure and physical activity, independent of overweight or obesity 6.

Pharmacologic Therapy

• 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, 7.
• The combination of an agent targeting the renin-angiotensin-aldosterone system with a calcium channel blocker and diuretic is rational, and triple combinations have demonstrated greater effectiveness compared with their respective dual-component combinations 8.
• Thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers are the preferred medications in nonblack patients; thiazide diuretics and calcium channel blockers are preferred in black patients 7.

Blood Pressure Targets

• The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk 4.
• An SBP reduction of 10 mm Hg decreases risk of CVD events by approximately 20% to 30% 4.
• A blood pressure goal of less than 140/90 mm Hg is recommended in patients with chronic kidney disease and in those with diabetes mellitus 7.