What is the initial treatment for diastolic hypertension?

From the Guidelines

The initial treatment for diastolic hypertension should begin with lifestyle modifications, and if blood pressure remains above 90 mmHg diastolic after 3-6 months, medication therapy should be initiated with first-line medications including thiazide diuretics, calcium channel blockers, ACE inhibitors, or ARBs, as recommended by the most recent guidelines 1.

Key Lifestyle Modifications

• Reducing sodium intake to less than 2.3g daily
• Adopting the DASH diet rich in fruits and vegetables
• Regular physical activity (150 minutes of moderate exercise weekly)
• Limiting alcohol consumption
• Maintaining a healthy weight
• Smoking cessation

Medication Therapy

• First-line medications: thiazide diuretics (such as hydrochlorothiazide 12.5-25mg daily), calcium channel blockers (like amlodipine 5-10mg daily), ACE inhibitors (such as lisinopril 10-40mg daily), or ARBs (such as losartan 50-100mg daily)
• Choice of medication depends on patient characteristics, including age, race, and comorbidities
• ACE inhibitors are preferred in patients with diabetes or chronic kidney disease, while calcium channel blockers may work better in Black patients
• Blood pressure should be monitored regularly, with a goal of achieving readings below 130/80 mmHg for most adults
• Medication dosages may need adjustment over time, and combination therapy is often required if single-drug treatment is insufficient, as supported by studies such as 1 and 1

Important Considerations

• The 2019 guidelines for the management of arterial hypertension recommend a goal blood pressure of < 130/80 mmHg for most adults 1
• The choice of medication should be tailored to the individual patient's characteristics and comorbidities
• Regular monitoring of blood pressure and adjustment of medication dosages as needed is crucial to achieve optimal blood pressure control and reduce the risk of cardiovascular events, as emphasized by studies such as 1 and 1

From the FDA Drug Label

DOSAGE & ADMINISTRATION 2. 1 Hypertension Initial Therapy in adults: The recommended initial dose is 10 mg once a day. The initial treatment for diastolic hypertension is lisinopril 10 mg once a day.

• The dose should be adjusted according to blood pressure response.
• The usual dosage range is 20 mg to 40 mg per day administered in a single daily dose. 2

From the Research

Initial Treatment for Diastolic Hypertension

The initial treatment for diastolic hypertension typically involves lifestyle modifications. Some key aspects of this approach include:

• Dietary changes: Emphasizing a healthy diet that is low in sodium and rich in fruits, vegetables, and low-fat dairy products can help lower blood pressure 3.
• Physical activity: Regular physical exercise is recommended as a critical component of first-line treatment for elevated blood pressure 4.
• Weight management: Maintaining a healthy weight is also important for managing blood pressure 5.
• Stress management and adequate sleep: These factors can also play a role in helping to lower blood pressure 5.

Lifestyle Interventions

Lifestyle interventions have been shown to be effective in reducing blood pressure in patients with hypertension. These interventions can include:

• A continuous care model that emphasizes physical activity and a heart-healthy diet 6.
• The Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, and low-fat dairy products 3.
• Regular physical activity, which can help to lower blood pressure and improve overall health 4.

Guidelines and Recommendations

Guidelines and recommendations for the treatment of diastolic hypertension typically suggest that lifestyle modifications be tried first, before moving on to medication. For example:

• The American Heart Association recommends lifestyle approaches as the first line of therapy for patients with mildly or moderately elevated blood pressure 4.
• Other guidelines suggest that antihypertensive drug treatment be initiated when systolic blood pressure is at least 140 or diastolic blood pressure is at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk 7.