From the Guidelines
The initial treatment of hypertension involves both lifestyle modifications and medication therapy, with a focus on reducing cardiovascular risk and improving quality of life.
Lifestyle Modifications
Lifestyle changes should be recommended for all patients and include:
- Regular physical activity (150 minutes of moderate-intensity exercise weekly)
- Weight reduction if overweight
- Adopting the DASH diet (rich in fruits, vegetables, and low-fat dairy with reduced saturated fat)
- Sodium restriction to less than 2.3g daily
- Limiting alcohol consumption
- Smoking cessation
Medication Therapy
For pharmacological treatment, first-line medications include ACE inhibitors, ARBs, thiazide-like diuretics, or dihydropyridine calcium channel blockers 1. Treatment choice depends on patient characteristics, with ACE inhibitors or ARBs preferred for those with diabetes or chronic kidney disease, as they have been shown to reduce the risk of progressive kidney disease 1.
Key Considerations
- Medication should be started at a low dose and titrated upward every 2-4 weeks until blood pressure goal is achieved, typically less than 130/80 mmHg.
- Multiple-drug therapy is generally required to achieve blood pressure targets, but combinations of ACE inhibitors and angiotensin receptor blockers and combinations of ACE inhibitors or angiotensin receptor blockers with direct renin inhibitors should not be used 1.
- For patients with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g), initial treatment should include an ACE inhibitor or ARB to reduce the risk of progressive kidney disease 1.
Monitoring and Follow-up
- Patients treated with an ACE inhibitor, angiotensin receptor blocker, or diuretic should have their serum creatinine/estimated glomerular filtration rate and serum potassium levels monitored at least annually 1.
- Lifestyle therapy plans should be developed in collaboration with the patient and discussed as part of diabetes management 1.
Overall, the goal of hypertension management is to reduce cardiovascular risk and improve quality of life, and treatment should be individualized based on patient characteristics and preferences.
From the FDA Drug Label
DOSAGE & ADMINISTRATION 2. 1 Hypertension Initial Therapy in adults: The recommended initial dose is 10 mg once a day. Many patients will require more than 1 drug to achieve blood pressure goals. Lisinopril tablets USP may be administered alone or with other antihypertensive agents
The initial treatment options for managing hypertension include:
- Lisinopril with an initial dose of 10 mg once a day
- Combination therapy with lisinopril and other antihypertensive agents
- Losartan as an alternative option, although the initial dose is not specified in the provided text 2, 2, 3
From the Research
Initial Treatment Options for Managing Hypertension
The initial treatment options for managing hypertension include lifestyle modification and pharmacologic therapy.
- Lifestyle modification is the first-line therapy for hypertension, consisting of:
- Weight loss
- Healthy dietary pattern with low sodium and high potassium intake
- Physical activity
- Moderation or elimination of alcohol consumption 4
- Pharmacologic therapy is initiated based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk.
- First-line drug therapy for hypertension consists of:
- A thiazide or thiazide-like diuretic such as hydrochlorothiazide or chlorthalidone
- An angiotensin-converting enzyme inhibitor or angiotensin receptor blocker such as enalapril or candesartan
- A calcium channel blocker such as amlodipine 4
Combination Therapy
Combination therapy is often required to achieve blood pressure control, and the use of fixed-dose combinations can improve compliance and reduce adverse events.
- The combination of an angiotensin II receptor blocker, a calcium channel blocker, and a thiazide diuretic is a rational combination for the treatment of hypertension 5
- The combination of an ACE inhibitor and a calcium channel blocker is also an optimal combination for the treatment of hypertension 6
Lifestyle Interventions
Lifestyle interventions play a crucial role in the prevention and treatment of hypertension.
- Regular physical exercise, body weight management, and healthy dietary patterns are effective in preventing and treating hypertension 7
- Other lifestyle interventions such as stress management and promotion of adequate sleep patterns coupled with circadian entrainment may also be beneficial 7
Choice of Antihypertensive Agents
The choice of antihypertensive agents depends on various factors, including the presence of compelling indications and the patient's tolerance to the medication.
- Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have similar efficacy in reducing blood pressure and cardiovascular outcomes, but ACE inhibitors are associated with a higher risk of adverse events such as cough and angioedema 8