What are the recommended treatments for hypertension?

From the Guidelines

The recommended treatment for hypertension includes lifestyle modifications and medications, with a goal to achieve blood pressure below 130/80 mmHg, as stated in the most recent guidelines 1.

Lifestyle Modifications

Lifestyle changes should be the first approach, including:

• Reducing sodium intake to less than 2,300 mg daily
• Following the DASH diet rich in fruits and vegetables
• Regular physical activity (150 minutes of moderate exercise weekly)
• Limiting alcohol consumption
• Maintaining healthy weight
• Quitting smoking

Medications

If blood pressure remains elevated despite lifestyle modifications, medications are typically prescribed. First-line medications include:

• Thiazide diuretics (like hydrochlorothiazide 12.5-25 mg daily)
• ACE inhibitors (such as lisinopril 10-40 mg daily)
• Angiotensin II receptor blockers (like losartan 25-100 mg daily)
• Calcium channel blockers (such as amlodipine 5-10 mg daily) Treatment is often started with a single medication at a low dose, then adjusted based on response. Many patients require two or more medications for adequate control.

Mechanism of Action

These treatments work by different mechanisms:

• Diuretics reduce blood volume
• ACE inhibitors and ARBs relax blood vessels by affecting the renin-angiotensin system
• Calcium channel blockers prevent calcium from entering heart and blood vessel cells, causing relaxation of vessels Regular monitoring is essential to ensure treatment effectiveness and minimize side effects, as recommended by recent studies 1. Key considerations in treatment selection include the presence of comorbid conditions, such as diabetes or heart failure, and the potential for drug interactions, as noted in various guidelines 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.

The recommended treatments for hypertension include:

• Losartan 2
• Lisinopril 3 Key points to consider when treating hypertension:
• Many patients will require more than one drug to achieve blood pressure goals
• Blood pressure reduction is largely responsible for reducing cardiovascular morbidity and mortality
• The choice of therapy may be guided by considerations such as the patient's population, additional approved indications, and effects on other conditions (e.g., angina, heart failure, or diabetic kidney disease)

From the Research

Recommended Treatments for Hypertension

The recommended treatments for hypertension include lifestyle modifications and drug therapy.

• Lifestyle modifications are recommended as the first-line treatment for hypertension, and they include:
  • Diet adaptation, such as the Dietary Approaches to Stop Hypertension (DASH) diet 4
  • Sodium reduction 4, 5, 6
  • Alcohol restriction 4, 5, 7, 6
  • Physical exercise 4, 5, 7, 6
  • Weight reduction 4, 5, 7, 6
• Drug therapy is recommended for patients who do not respond to lifestyle modifications or who have high-risk factors.
  • First-line drug therapy includes thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and calcium channel blockers 5

Lifestyle Modifications

Lifestyle modifications are crucial in the treatment of hypertension and should be recommended to most hypertensive patients.

• These modifications can help reduce blood pressure and enhance the effects of antihypertensive therapy 4, 5, 7, 6, 8
• The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk 5

Combination Therapy

Combining lifestyle modifications with drug treatment can be an effective approach to managing mild to moderate hypertension.

• Randomized clinical trials have shown that combined therapy can be superior to lifestyle alone, drug alone, or no treatment in terms of blood pressure reduction and control 8
• Combined therapy can also reduce the amount of drugs required and improve side effects and quality of life 8