From the Guidelines
Stage 2 hypertension is typically defined as a blood pressure of 160/100 mmHg or higher, and its treatment involves the initiation of two antihypertensive agents from different classes when the average systolic blood pressure (SBP) and diastolic blood pressure (DBP) are more than 20 and 10 mmHg above target, respectively. According to the 2017 American College of Cardiology/American Heart Association hypertension guideline 1, patients with stage 2 hypertension should be treated promptly, carefully monitored, and have prompt adjustment of their regimen until control is achieved.
Key Considerations for Treatment
- The preferred options for first-line therapy in most U.S. adults are thiazide diuretics (especially chlorthalidone) and calcium-channel blockers due to their efficacy 1.
- For black patients, including those with diabetes, thiazide diuretics and calcium-channel blockers are recommended as first-line agents, whereas β-blockers and renin–angiotensin system inhibitors are less effective at lowering blood pressure 1.
- Lifestyle modifications, including adopting the DASH diet, reducing sodium intake, regular physical activity, limiting alcohol consumption, maintaining a healthy weight, and quitting smoking, are also crucial components of treatment.
Medication Therapy
- A combination of two antihypertensive drugs from different classes, such as a thiazide diuretic, an ACE inhibitor, an ARB, or a calcium channel blocker, is often prescribed.
- The choice of antihypertensive drug therapy should be based on the patient's individual characteristics, such as the presence of diabetes or kidney disease.
- Blood pressure should be monitored regularly, with a target of below 130/80 mmHg for most adults, and medication adherence is crucial to achieving blood pressure control 1.
From the FDA Drug Label
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 The FDA drug label does not answer the question.
From the Research
Definition of Stage 2 Hypertension
- Stage 2 hypertension is defined as a systolic blood pressure of 140 mmHg or higher, or a diastolic blood pressure of 90 mmHg or higher 2, 3, 4.
- According to the American College of Cardiology, stage 2 hypertension is considered a serious health condition that requires immediate medical attention and lifestyle changes.
Treatment for Stage 2 Hypertension
- The primary treatment for stage 2 hypertension includes lifestyle modifications, such as:
- Reducing sodium intake
- Increasing physical activity
- Losing weight
- Quitting smoking
- Reducing stress
- Medications may also be prescribed, including:
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin receptor blockers (ARBs)
- Calcium channel blockers (CCBs)
- Diuretics
- Studies have shown that ACE inhibitors and ARBs are effective in reducing blood pressure and preventing cardiovascular events in patients with stage 2 hypertension 2, 3, 5.
- However, CCBs have also been shown to be effective in reducing blood pressure and may be considered as an alternative to ACE inhibitors and ARBs, especially in patients with certain medical conditions 3, 6.
Medication Options
- ACE inhibitors, such as lisinopril, have been shown to be effective in reducing blood pressure and preventing cardiovascular events in patients with stage 2 hypertension 2, 5.
- ARBs, such as losartan, have also been shown to be effective in reducing blood pressure and preventing cardiovascular events in patients with stage 2 hypertension 2, 4.
- CCBs, such as amlodipine, have been shown to be effective in reducing blood pressure and may be considered as an alternative to ACE inhibitors and ARBs, especially in patients with certain medical conditions 3, 6.