What medications are recommended by the American Heart Association (AHA) for the management of Hypertension (HTN)?

From the Guidelines

The American Heart Association recommends first-line treatments for hypertension management to include thiazide diuretics, calcium channel blockers, ACE inhibitors, and angiotensin II receptor blockers, with a goal to reduce blood pressure to less than 130/80 mmHg for most adults. According to the most recent guidelines 1, the recommended first-line treatments for hypertension management include:

• Thiazide diuretics (like chlorthalidone and hydrochlorothiazide)
• Calcium channel blockers (such as amlodipine and diltiazem)
• ACE inhibitors (like lisinopril and enalapril)
• Angiotensin II receptor blockers (ARBs, such as losartan and valsartan) For most patients with uncomplicated hypertension, treatment typically begins with a single agent at a low dose, which can be titrated upward if blood pressure goals aren't met. Some key points to consider when selecting medications for hypertension management include:
• Combination therapy with two first-line agents from different classes is often recommended for patients with stage 2 hypertension (BP ≥140/90 mmHg)
• Beta-blockers are generally reserved for patients with specific comorbidities such as heart failure or prior myocardial infarction
• Aldosterone antagonists are useful as add-on therapy for resistant hypertension
• Medication selection should be individualized based on patient characteristics, comorbidities, and potential side effects, as supported by the 2018 AHA guidelines 1 The goal of therapy is to reduce blood pressure to less than 130/80 mmHg for most adults, as this level has been shown to reduce the risk of cardiovascular events, stroke, and kidney disease. In terms of specific medication selection, the 2024 ESC guidelines 1 recommend that ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics have demonstrated the most effective reduction of BP and CVD events, and are therefore recommended as first-line treatments to lower BP. Additionally, the guidelines recommend that combination BP-lowering treatment is recommended for most patients with confirmed hypertension as initial therapy, with preferred combinations including a RAS blocker with a dihydropyridine CCB or diuretic.

From the Research

Medications for Hypertension (HTN) Management

The American Heart Association (AHA) recommends the following medications for the management of Hypertension (HTN):

• Thiazide diuretics, such as chlorthalidone or hydrochlorothiazide, as the first-line treatment for hypertension in adults without diabetes or cardiovascular or renal disease 2
• Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril, as an alternative to thiazide diuretics 2
• Calcium channel blockers, such as amlodipine, as an alternative to thiazide diuretics or ACE inhibitors 3
• Beta-blockers, such as atenolol, as an alternative to thiazide diuretics or ACE inhibitors 4

Dosage and Efficacy

• The dose-related blood pressure-lowering effect of thiazide diuretics, such as hydrochlorothiazide, has been shown to be effective in reducing blood pressure 5
• The maximal blood pressure-lowering effect of different thiazides has been shown to be similar 5
• Thiazides have a greater effect on systolic than on diastolic blood pressure, resulting in a reduction in pulse pressure 5

Treatment Guidelines

• The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines recommend treating patients with a systolic blood pressure between 120-129 mmHg with lifestyle measures, and adding medication for those with a systolic blood pressure ≥130 mmHg or a diastolic blood pressure ≥80 mmHg 6
• The guidelines also recommend initiating antihypertensive drug therapy with two first-line drugs from different classes for patients with a blood pressure ≥140/90 mmHg or with a blood pressure > 20/10 mmHg above their blood pressure target 6