From the Guidelines
Hypertension treatment should typically begin with lifestyle modifications and, if necessary, medication therapy with first-line medications such as thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers, and calcium channel blockers, with a target blood pressure of less than 150 mm Hg for adults aged 60 years or older, as recommended by the American College of Physicians and the American Academy of Family Physicians 1.
Key Considerations
- Lifestyle modifications, including weight loss, regular exercise, reduced sodium intake, limited alcohol consumption, and a diet rich in fruits and vegetables, are essential for managing hypertension.
- Medication therapy should be initiated if lifestyle modifications are insufficient, with first-line medications including:
- Thiazide diuretics (like hydrochlorothiazide 12.5-25mg daily)
- ACE inhibitors (such as lisinopril 10-40mg daily)
- Angiotensin II receptor blockers (like losartan 25-100mg daily)
- Calcium channel blockers (such as amlodipine 5-10mg daily)
- Treatment should be started with a single agent at a low dose, then titrated upward if blood pressure remains uncontrolled, with combination therapy including different drug classes that work synergistically.
- Beta-blockers (like metoprolol 25-100mg twice daily) are typically reserved for patients with specific indications such as coronary artery disease or heart failure.
Recent Guidelines
The World Health Organization guideline executive summary 1 provides evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension, recommending a blood pressure threshold to initiate pharmacological therapy, blood pressure treatment targets, and intervals for follow-up visits.
Monitoring and Adjustment
Regular monitoring is essential to assess medication effectiveness and adjust therapy as needed, with blood pressure goals generally targeting readings below 130/80 mmHg, though this may vary based on age and comorbidities.
From the FDA Drug Label
Aliskiren tablets are indicated for the treatment of hypertension in adults and in pediatric patients weighing 50 kg or greater who are at least 6 years of age and older to lower blood pressure. Many patients will require more than 1 drug to achieve blood pressure goals Numerous antihypertensive drugs, from a 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
Treatment options for hypertension include:
- Aliskiren tablets: indicated for the treatment of hypertension in adults and pediatric patients weighing 50 kg or greater who are at least 6 years of age and older
- Combination therapy: many patients will require more than one drug to achieve blood pressure goals
- Other antihypertensive drugs: numerous antihypertensive drugs from various pharmacologic classes have been shown to reduce cardiovascular morbidity and mortality 2
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 3
- The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk 3
- 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 3, 4, 5
Combination Therapy
- More than 70% of adults treated for primary hypertension will eventually require at least two antihypertensive agents 4
- Four main classes of medications are used in combination therapy for the treatment of hypertension: thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers 4
- ACEIs and ARBs should not be used simultaneously, and in black patients, at least one agent should be a thiazide diuretic or a calcium channel blocker 4
Lifestyle Interventions
- Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, can help prevent and treat hypertension 6, 7
- Applying lifestyle intervention in the form of a continuous care model can reduce dietary sodium intake and blood pressure in patients with hypertension 6
- Stress management and promotion of adequate sleep patterns coupled with circadian entrainment may also have beneficial effects on hypertension 7