From the Guidelines
The initial treatment for hypertension should involve combination BP-lowering treatment, preferably a RAS blocker with a dihydropyridine CCB or diuretic, as initial therapy for most patients with confirmed hypertension (BP ≥140/90 mmHg). This approach is based on the latest guidelines from the European Heart Journal, which emphasize the importance of effective BP control to reduce cardiovascular disease events 1. The recommended first-line treatments include ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics, which have demonstrated the most effective reduction of BP and CVD events 1.
When selecting the initial treatment, it is essential to consider patient characteristics, such as age, comorbidities, and potential side effects. For example, beta-blockers can be combined with other BP-lowering drugs when there are compelling indications, such as angina, post-myocardial infarction, or heart failure with reduced ejection fraction 1. Additionally, fixed-dose single-pill combination treatment is recommended for patients receiving combination BP-lowering treatment to improve adherence 1.
Key points to consider when initiating treatment for hypertension include:
- Starting with a combination of two drugs, preferably a RAS blocker with a dihydropyridine CCB or diuretic, for most patients with confirmed hypertension (BP ≥140/90 mmHg) 1
- Using fixed-dose single-pill combination treatment to improve adherence 1
- Avoiding the combination of two RAS blockers (ACE inhibitor and an ARB) due to the lack of benefit and potential increased risk of adverse effects 1
- Considering the addition of spironolactone or other agents if BP is not controlled with a three-drug combination 1
By following these guidelines and considering individual patient characteristics, healthcare providers can develop an effective treatment plan for hypertension that prioritizes morbidity, mortality, and quality of life.
From the FDA Drug Label
DOSAGE & ADMINISTRATION 2. 1 Hypertension Initial Therapy in adults: The recommended initial dose is 10 mg once a day. Therapy should be initiated with the lowest possible dose. This dose should be titrated according to individual patient response to gain maximal therapeutic benefit while maintaining lowest dosage possible. The recommended initial daily dose is 25 mg to 100 mg of spironolactone tablets administered in either single or divided doses is recommended.
The initial treatment for hypertension is:
- Lisinopril (PO): 10 mg once a day 2
- Chlorthalidone (PO): 25 mg once a day 3
- Spironolactone (PO): 25 mg to 100 mg daily 4
From the Research
Initial Treatment for Hypertension
The initial treatment for hypertension typically involves a combination of lifestyle modifications and, if necessary, medication.
- Lifestyle modifications are considered first-line therapy for hypertension, including:
- Weight loss
- Healthy dietary pattern with low sodium and high potassium intake
- Physical activity
- Moderation or elimination of alcohol consumption
- These lifestyle components have been shown to have partially additive BP-lowering effects and can enhance the efficacy of pharmacologic therapy 5.
- If medication is required, first-line drug therapy for hypertension consists of:
- Thiazide or thiazide-like diuretics (e.g., hydrochlorothiazide or chlorthalidone)
- Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (e.g., enalapril or candesartan)
- Calcium channel blockers (e.g., amlodipine)
- These medications should be titrated according to office and home blood pressure levels to achieve a target blood pressure of <130/80 mm Hg for adults <65 years and <130 mm Hg for adults ≥65 years 5, 6, 7.
Importance of Lifestyle Interventions
Lifestyle interventions are crucial in the prevention and treatment of hypertension.
- A randomized controlled trial found that applying lifestyle intervention in the form of a continuous care model can reduce dietary sodium intake and blood pressure in patients with hypertension 8.
- Another study found that lifestyle modifications, such as regular physical exercise, body weight management, and healthy dietary patterns, can have preventive and antihypertensive effects 9.
- The physiological mechanisms underlying the beneficial effects of lifestyle interventions on hypertension include improvements in vascular health, reduced sympathetic overactivation, and increased secretion of myokines 9.