From the Guidelines
The management of Hypertensive Heart Disease (HHD) should focus on controlling blood pressure, reducing cardiac workload, and addressing complications, with a target BP <130/80 mmHg, as recommended by the most recent guidelines 1. The first-line treatment includes lifestyle modifications such as:
- Weight reduction
- Adopting the DASH diet (rich in fruits, vegetables, and low-fat dairy)
- Sodium restriction to <2.3g daily
- Regular aerobic exercise (150 minutes weekly)
- Limiting alcohol consumption
- Smoking cessation Pharmacological therapy typically begins with antihypertensive medications, including:
- ACE inhibitors (like lisinopril 10-40mg daily) or ARBs (such as losartan 25-100mg daily), which reduce left ventricular hypertrophy and improve outcomes in heart failure 1
- Diuretics (hydrochlorothiazide 12.5-25mg daily) to manage volume overload
- Beta-blockers (metoprolol 25-200mg daily) may be added, especially with coexisting coronary artery disease or heart failure
- Calcium channel blockers (amlodipine 5-10mg daily) are also effective options For patients with heart failure symptoms, additional medications like aldosterone antagonists (spironolactone 25-50mg daily) may be beneficial 1. Regular monitoring of blood pressure, renal function, and electrolytes is essential, with follow-up every 3-6 months for stable patients, as recommended by the American Heart Association 1. These interventions work by reducing cardiac afterload, preventing pathological remodeling, and improving myocardial oxygen supply-demand balance, ultimately slowing disease progression and reducing cardiovascular morbidity and mortality. The addition of hydralazine/isosorbide dinitrate to the background regimen of a diuretic, an ACE inhibitor or ARB, and a β-blocker treatment in self-described black patients with HFrEF and with persistent New York Heart Association (NYHA) class III or IV HF symptoms is beneficial to reduce morbidity and mortality 1. Drugs to avoid in patients with HF and hypertension include nondihydropyridine calcium channel blockers (eg, verapamil and diltiazem) and moxonidine, as they may cause harm 1.
From the FDA Drug Label
INDICATIONS & USAGE 1. 1 Hypertension 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 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 management for Hypertensive Heart Disease (HHI) involves:
- Lowering blood pressure to reduce the risk of fatal and non-fatal cardiovascular events
- Comprehensive cardiovascular risk management, including:
- Lipid control
- Diabetes management
- Antithrombotic therapy
- Smoking cessation
- Exercise
- Limited sodium intake
- Using antihypertensive drugs, such as lisinopril, to achieve blood pressure goals 2
From the Research
Management of Hypertensive Heart Disease (HHI)
The management of Hypertensive Heart Disease (HHI) involves the use of various antihypertensive agents to control blood pressure and reduce cardiovascular risk.
- The combination of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors is of special interest due to their complementary actions on the sympathetic nervous system and renin-angiotensin-aldosterone system 3.
- Beta-blockers are used to manage arrhythmias, treat angina pectoris, and heart failure, while ACE inhibitors provide cardioprotection in patients with acute coronary syndromes and treat congestive heart failure 3.
- Combining beta-blockers and ACE inhibitors into a single pill can provide effective blood pressure lowering and improved cardiovascular outcomes, allowing a greater proportion of patients to rapidly achieve treatment targets 3.
Antihypertensive Treatment Options
- ACE inhibitors have been associated with a lower risk of incident atrial fibrillation (AF) in patients with hypertension, compared to diuretics 4.
- Beta-blockers have not been shown to have a significant association with lower AF risk, although they are still used to manage various cardiovascular conditions 4.
- The choice of antihypertensive treatment should be tailored to individual patients based on their hypertension subclass and cardiovascular risk profile 3.