From the Guidelines
Hypertension treatment should begin with lifestyle modifications, including weight loss, regular exercise, reduced sodium intake, limited alcohol consumption, and a diet rich in fruits, vegetables, and low-fat dairy products, as recommended by the most recent guidelines 1.
Lifestyle Modifications
- Weight loss if overweight or obese
- Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern
- Reducing sodium intake to less than 2,300 mg/day
- Increasing potassium intake
- Moderation of alcohol intake
- Increased physical activity
Pharmacological Treatment
For patients with confirmed office-based blood pressure ≥140/90 mmHg, pharmacological therapy should be initiated promptly, in addition to lifestyle therapy, to achieve blood pressure goals 1.
- First-line medications include:
- Thiazide diuretics (like hydrochlorothiazide 12.5-25mg daily)
- ACE inhibitors (such as lisinopril 10-40mg daily)
- Angiotensin II receptor blockers (like losartan 50-100mg daily)
- Calcium channel blockers (such as amlodipine 5-10mg daily)
- Treatment goals typically aim for blood pressure below 130/80 mmHg for most adults
- Medication selection should consider the patient's age, race, comorbidities, and potential side effects
- Combination therapy is often necessary to achieve target blood pressure, with different medication classes working synergistically
- Regular monitoring is essential to assess efficacy and adjust treatment as needed, with monitoring of serum creatinine/estimated glomerular filtration rate and serum potassium levels at least annually for patients treated with an ACE inhibitor, angiotensin receptor blocker, or diuretic 1.
Importance of Hypertension Control
Hypertension control is crucial as it significantly reduces the risk of stroke, heart attack, heart failure, and kidney disease by decreasing pressure on arterial walls and reducing cardiovascular workload.
- The benefits of hypertension treatment in patients with diabetes are well-established, with reductions in cardiovascular events and mortality 1
- Regular monitoring and adjustment of treatment are necessary to achieve and maintain optimal blood pressure control.
From the FDA Drug Label
Doxazosin tablets, USP are indicated for the treatment of hypertension, 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.
Treatment Options for Hypertension:
- Doxazosin: may be used alone or in combination with other antihypertensives to lower blood pressure.
- Lisinopril: may be administered alone or with other antihypertensive agents to lower blood pressure.
The treatment of hypertension should be part of comprehensive cardiovascular risk management, including lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake 2 3. Many patients will require more than one drug to achieve blood pressure goals.
From the Research
Treatment of Hypertension
- 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.
- 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, 7, 8.
Lifestyle Modifications
- Maintaining healthy lifestyle factors, such as body mass index, diet, smoking, alcohol consumption, sodium excretion, and sedentary behavior, could lower systolic blood pressure by 3.5 mm Hg and reduce the risk of cardiovascular disease (CVD) by about 30% 5.
- Lifestyle modifications, such as reducing salt, sodium, and fat intake, changing eating habits to include more fruits and vegetables, not smoking, consuming less alcohol, exercising regularly, maintaining healthy body weight, and minimizing stressful conditions, can affect blood pressure by modulating visceral fat accumulation, insulin resistance, the renin-angiotensin-aldosterone system, vascular endothelial function, oxidative stress, inflammation, and autonomic function 5.
- Applying lifestyle intervention in the form of a continuous care model (CCM) may be recommended to reduce dietary sodium intake and mean systolic and diastolic blood pressure in patients who are hypertensive 7.
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, and should be titrated according to office and home SBP/DBP levels to achieve a target blood pressure of <130/80 mm Hg for adults <65 years and SBP <130 mm Hg in adults ≥65 years 4.
- Randomized clinical trials have established the efficacy of blood pressure lowering to reduce the risk of CVD morbidity and mortality, with an SBP reduction of 10 mm Hg decreasing the risk of CVD events by approximately 20% to 30% 4.
Blood Pressure Targets
- 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 6.
- Reducing diastolic blood pressure to less than 90 mm Hg is beneficial in adults older than 30 years, while reducing systolic blood pressure to less than 150 mm Hg is recommended in adults older than 60 years 6.