What is the recommended treatment approach for patients with hypertension?

From the Guidelines

The recommended treatment approach for patients with hypertension should prioritize lifestyle modifications and, when necessary, pharmacological therapy with first-line medications such as thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers, or calcium channel blockers, with a goal to achieve blood pressure targets generally <130/80 mmHg 1.

Key Components of Hypertension Management

• Lifestyle modifications are crucial for all patients, including weight reduction, adopting the DASH diet, reducing sodium intake to less than 2.3g daily, regular physical activity, and limiting alcohol consumption.
• Pharmacological therapy typically starts with a single agent at a low dose, with options including thiazide diuretics (like hydrochlorothiazide 12.5-25mg daily), ACE inhibitors (such as lisinopril 10-40mg daily), angiotensin II receptor blockers (like losartan 25-100mg daily), or calcium channel blockers (amlodipine 5-10mg daily) 1.
• For stage 2 hypertension (BP ≥140/90 mmHg), initiating therapy with two medications is often recommended, especially in patients with higher BPs or those at greater risk, to rapidly achieve blood pressure control 1.
• Regular monitoring is essential, with follow-up appointments every 2-4 weeks until blood pressure is controlled, then every 3-6 months thereafter.

Considerations for Resistant Hypertension

• In patients with resistant hypertension, reinforcement of lifestyle measures, especially sodium restriction, is recommended 1.
• Addition of low-dose spironolactone to existing treatment, or further diuretic therapy if intolerant to spironolactone, can be considered 1.
• For patients with uncontrolled BP despite first-line therapies, catheter-based renal denervation may be considered if performed at a medium-to-high volume center, after a shared risk-benefit discussion and multidisciplinary assessment 1.

From the FDA Drug Label

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. Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake Many patients will require more than 1 drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)

The recommended treatment approach for patients with hypertension is to lower blood pressure as part of comprehensive cardiovascular risk management, which may include:

• Lipid control
• Diabetes management
• Antithrombotic therapy
• Smoking cessation
• Exercise
• Limited sodium intake Many patients will require more than one drug to achieve blood pressure goals, and treatment should be guided by published guidelines such as those of the JNC 2.

From the Research

Treatment Approach for Patients with Hypertension

The recommended treatment approach for patients with hypertension involves a combination of lifestyle modifications and pharmacological interventions.

• The decision to initiate antihypertensive drug treatment should be based on the patient's blood pressure levels and their total cardiovascular risk, as stated in 3.
• The American College of Cardiology/American Heart Association (ACC/AHA) guideline provides updated recommendations for antihypertensive medication initiation and intensification, as discussed in 4.
• According to 5, initiating combination therapy, such as ACEI-thiazide diuretic combination therapy, may be more effective in achieving blood pressure goals compared to monotherapy.
• First-line thiazide and thiazide-like diuretics are compared with other antihypertensive drug classes, including beta-blockers, calcium channel blockers, ACE inhibitors, and alpha-adrenergic blockers, in 6.
• The choice of antihypertensive drug should be personalized, taking into account the patient's individual characteristics and comorbidities, as suggested in 7.

Key Considerations

When initiating antihypertensive treatment, the following key considerations should be taken into account:

• Blood Pressure Targets: The target blood pressure levels should be individualized based on the patient's risk factors and comorbidities, as discussed in 3 and 4.
• Pharmacological Treatment: The choice of antihypertensive drug should be based on the patient's individual characteristics, such as age, sex, and comorbidities, as suggested in 6 and 7.
• Lifestyle Modifications: Lifestyle modifications, such as dietary changes and increased physical activity, should be encouraged in all patients with hypertension, as recommended in 7 and 4.
• Regular Monitoring: Regular monitoring of blood pressure and cardiovascular risk factors is essential to adjust treatment and prevent cardiovascular events, as emphasized in 5 and 4.