What are the treatment options for hypertension (high blood pressure)?

From the Guidelines

The most effective treatment for hypertension involves a combination of lifestyle modifications and medication, with the goal of lowering blood pressure to below 130/80 mmHg, as recommended by the most recent guidelines 1.

Lifestyle Modifications

Lifestyle changes are essential in managing hypertension and include:

• Reducing salt intake
• Increasing physical activity
• Maintaining a healthy weight
• Limiting alcohol consumption
• Adopting a heart-healthy diet like the DASH diet

Medication

First-line medications for hypertension include:

• Thiazide diuretics, such as hydrochlorothiazide (12.5-25 mg daily)
• Calcium channel blockers (CCBs), such as amlodipine (5-10 mg daily)
• Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril (10-40 mg daily)
• Angiotensin receptor blockers (ARBs), such as losartan (50-100 mg daily) Treatment often starts with one medication and may require combination therapy to achieve target blood pressure.

Choice of Medication

The choice of medication depends on the patient's age, race, comorbidities, and potential side effects. For instance:

• ACE inhibitors are often preferred in patients with diabetes or heart failure, while CCBs may be more effective in African American patients
• Diuretic-based antihypertensive therapies have been shown to prevent heart failure in a wide range of target populations as first-line therapy 1
• ACE inhibitors and ARBs have also been shown to be very effective in the prevention of heart failure, especially in patients with left ventricular systolic dysfunction or patients after myocardial infarction

Monitoring and Adherence

Patients should be advised to monitor their blood pressure at home and report any side effects or concerns to their healthcare provider. Adherence to both medication and lifestyle changes is crucial for effective hypertension management and reducing the risk of cardiovascular complications. Regular monitoring is crucial, and medication adjustments may be necessary to achieve target blood pressure. The most recent guidelines recommend that the target blood pressure should be below 130/80 mmHg for most adults, with consideration given to lowering the blood pressure even further, to below 120/80 mmHg, in certain patients 1.

From the FDA Drug Label

Losartan is indicated for the treatment of hypertension in adults and pediatric patients 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 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. 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 treatment options for hypertension (high blood pressure) include:

• Losartan 2
• Lisinopril 3
• Combination therapy with more than one antihypertensive agent
• Comprehensive cardiovascular risk management, including:
  • Lipid control
  • Diabetes management
  • Antithrombotic therapy
  • Smoking cessation
  • Exercise
  • Limited sodium intake

From the Research

Treatment Options for Hypertension

The treatment options for hypertension can be categorized into lifestyle modifications and pharmacologic therapy.

• Lifestyle modifications are considered the first-line therapy for hypertension, including:
  • Weight loss 4, 5, 6, 7, 8
  • Healthy dietary pattern with low sodium and high potassium intake 4, 5, 6, 7, 8
  • Physical activity 4, 5, 6, 7, 8
  • Moderation or elimination of alcohol consumption 4, 5, 6, 7, 8
• Pharmacologic therapy is considered when lifestyle modifications are not sufficient to control blood pressure.
  • First-line drug therapy for hypertension consists of:
    • Thiazide or thiazide-like diuretics such as hydrochlorothiazide or chlorthalidone 4, 6
    • Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers such as enalapril or candesartan 4, 6
    • Calcium channel blockers such as amlodipine 4, 6

Blood Pressure Targets

The target blood pressure levels are:

• Less than 130/80 mm Hg for adults under 65 years 4
• Less than 130 mm Hg for adults 65 years and older 4
• Less than 140/90 mm Hg for patients with chronic kidney disease and diabetes mellitus 6

Importance of Treatment

Treatment of hypertension is crucial to reduce the risk of cardiovascular disease events and death 4, 5, 6, 7, 8. Randomized clinical trials have established the efficacy of blood pressure lowering to reduce the risk of cardiovascular disease morbidity and mortality 4.