From the Guidelines
The American Heart Association guidelines for hypertension medication management recommend initiating pharmacotherapy when blood pressure consistently exceeds 130/80 mmHg with cardiovascular risk factors or 140/90 mmHg without risk factors, as stated in the 2017 ACC/AHA guideline 1.
Key Recommendations
- First-line medications include thiazide diuretics (like chlorthalidone 12.5-25 mg daily), calcium channel blockers (such as amlodipine 2.5-10 mg daily), ACE inhibitors (like lisinopril 10-40 mg daily), or ARBs (such as losartan 25-100 mg daily) 1.
- Treatment should begin with a single medication at a low dose, with dose adjustments every 2-4 weeks until target blood pressure is achieved.
- For stage 2 hypertension (≥140/90 mmHg), two medications from different classes are often started simultaneously.
- Combination therapy is frequently necessary, with medications preferably taken once daily to improve adherence.
Special Considerations
- African Americans typically respond better to thiazides and calcium channel blockers, while ACE inhibitors or ARBs are preferred for patients with diabetes or chronic kidney disease 1.
- Regular monitoring is essential, with blood pressure goals generally below 130/80 mmHg for most adults.
- Lifestyle modifications including reduced sodium intake, regular physical activity, weight management, and limited alcohol consumption should accompany medication therapy for optimal blood pressure control.
Guideline Development
The 2017 ACC/AHA guideline was developed by a multidisciplinary committee of experts, including physicians, nurses, pharmacists, and patient representatives, with no BP-related industry relationships 1. The guideline provides an evidence-based approach to reduction of CVD risk through lowering of blood pressure (BP) 1.
From the FDA Drug Label
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 FDA drug label does not answer the question about the American Heart Association (AHA) guidelines for hypertension medication management. The labels mention the National High Blood Pressure Education Program's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) but not the AHA guidelines.
From the Research
AHA Guidelines for Hypertension Medication Management
The American Heart Association (AHA) provides guidelines for the management of hypertension, including lifestyle modifications and medication therapy.
- The AHA recommends lifestyle modifications as the first line of treatment for hypertension, including weight loss, exercise, moderation of alcohol use, and cessation of smoking 2.
- For patients with hypertension, the AHA recommends a blood pressure goal of <140/90 mm Hg, but <130/80 mm Hg for patients with diabetes mellitus, chronic kidney disease, known coronary artery disease, or a 10-year Framingham risk score of ≥10% 3.
- The AHA recommends the following antihypertensive medications:
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) as first-line therapy for primary coronary artery disease (CAD) prevention 3.
- Beta-blockers and ACE inhibitors (or ARBs) as the basis of treatment for patients with established CAD (stable or unstable angina, non-ST-segment elevation myocardial infarction, ST-segment elevation myocardial infarction) 3.
- Thiazide diuretics, calcium channel blockers, and ACE inhibitors as effective antihypertensive medications for patients with hypertension 3, 4.
- For patients with chronic kidney disease (CKD), the AHA recommends a blood pressure goal of <130/80 mm Hg and the use of ACE inhibitors or ARBs as first-line therapy 5.
- The AHA also recommends lifestyle modifications, such as weight loss, exercise, and sodium restriction, to reduce blood pressure and minimize the need for antihypertensive medications 2, 6.