What are the treatment options for hypertension?

From the Guidelines

Hypertension treatment should prioritize lifestyle modifications, including reducing sodium intake to less than 2.3g daily, adopting the DASH diet, and regular physical activity, alongside medications such as thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers, with a treatment goal of blood pressure below 130/80 mmHg, as recommended by the most recent guidelines 1. The management of hypertension involves a multifaceted approach, incorporating both lifestyle changes and pharmacological interventions. Key lifestyle modifications include:

• Reducing sodium intake to less than 2.3g daily
• Adopting the DASH diet rich in fruits and vegetables
• Engaging in regular physical activity, such as 150 minutes of moderate exercise weekly
• Limiting alcohol consumption
• Maintaining a healthy weight
• Quitting smoking These lifestyle changes are crucial as they not only lower blood pressure but also enhance the effectiveness of antihypertensive medications and promote overall metabolic and vascular health, with minimal adverse effects 1. In terms of pharmacological treatment, first-line options include:
• Thiazide diuretics, such as hydrochlorothiazide 12.5-25mg daily
• ACE inhibitors, such as lisinopril 10-40mg daily
• ARBs, such as losartan 25-100mg daily
• Calcium channel blockers, such as amlodipine 5-10mg daily The choice of medication depends on various factors, including the patient's comorbidities, age, and potential side effects. Combination therapy is often necessary, with different medication classes working synergistically to achieve optimal blood pressure control 1. The treatment goals for hypertension typically aim for blood pressure below 130/80 mmHg, although targets may vary based on age and comorbidities. Regular monitoring is essential, as hypertension management is typically lifelong. The most recent guidelines from the European Society of Cardiology, published in 2024, provide a comprehensive approach to managing elevated blood pressure and hypertension, including recommendations for resistant hypertension 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE

1. 1 Hypertension 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.

INDICATIONS & USAGE

1. 1 Hypertension 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.

Hypertension Treatment:

• Aliskiren tablets are 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.
• Lisinopril tablets are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older. Both aliskiren 2 and lisinopril 3 can be used to treat hypertension by lowering blood pressure, which reduces the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions.

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.
• The condition 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, physical activity, and moderation or elimination of alcohol consumption 4, 5.
• The Dietary Approaches to Stop Hypertension diet, sodium restriction, regular exercise, and moderate weight loss are associated with improvements in blood pressure 6.
• Physical activity has extensive benefits, including improving both blood pressure and blood cholesterol, and is a critical component of first-line treatment for elevated blood pressure or cholesterol 7.

Pharmacologic Therapy

• First-line drug therapy for hypertension consists of a thiazide or thiazidelike diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 4, 8.
• The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk 4.
• Combination therapy may be necessary for patients who do not achieve adequate blood pressure control with monotherapy and lifestyle modifications 8.

Blood Pressure Targets

• The target blood pressure is less than 130/80 mm Hg for adults under 65 years and less than 130 mm Hg for adults 65 years and older 4.
• Reducing diastolic blood pressure to less than 90 mm Hg is beneficial in adults older than 30 years, and reducing systolic blood pressure to less than 150 mm Hg is beneficial in adults older than 60 years 6.