What is the approach to managing hypertension?

From the Guidelines

The management of hypertension involves a comprehensive approach combining lifestyle modifications and medication therapy, with the goal of maintaining blood pressure below 130/80 mmHg for most adults, as recommended by the most recent guidelines 1.

Key Components of Hypertension Management

• Lifestyle modifications:
  • Adopting the DASH diet (rich in fruits, vegetables, whole grains, and low-fat dairy)
  • Reducing sodium intake to less than 2.3g daily
  • Regular physical activity (150 minutes of moderate exercise weekly)
  • Limiting alcohol consumption
  • Maintaining healthy weight
  • Smoking cessation
• Medication therapy:
  • First-line medications include thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers
  • Treatment typically begins with a single agent at a low dose, with gradual increases or addition of a second medication if blood pressure targets aren't achieved

Considerations for Medication Selection

• Patient's comorbidities, age, race, and potential side effects should be considered when selecting medication
• For example, ACE inhibitors are preferred in patients with diabetes or heart failure, while calcium channel blockers may be more effective in Black patients

Monitoring and Follow-up

• Regular monitoring of blood pressure and kidney function is essential
• Patients should be encouraged to use home blood pressure monitoring This approach works by addressing both behavioral factors that contribute to hypertension and using medications that target different physiological mechanisms controlling blood pressure, including fluid volume, vascular resistance, and cardiac output, as supported by recent guidelines 1.

From the FDA Drug Label

With patients whose hypertension is complicated by congestive heart failure, care should be taken to differentiate this peripheral edema from the effects of increasing left ventricular dysfunction. The usual initial dose of Furosemide tablets for hypertension is 80 mg, usually divided into 40 mg twice a day. The approach to managing hypertension involves careful monitoring of blood pressure and differentiation of peripheral edema from left ventricular dysfunction, especially in patients with congestive heart failure.

• Key considerations:
  • Initial dose of Furosemide tablets for hypertension is 80 mg, divided into 40 mg twice a day.
  • Careful monitoring of blood pressure is necessary when using Furosemide tablets with other antihypertensive drugs.
  • Dosage of other agents should be reduced by at least 50% when Furosemide tablets are added to the regimen 2
  • The dose of nifedipine extended-release tablets should be carefully monitored and dose reduction may be necessary in patients with cirrhosis or liver impairment 3

From the Research

Approach to Managing Hypertension

The approach to managing hypertension involves the use of various medications, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, calcium channel blockers, and diuretics.

• The use of ACE inhibitors is preferred as initial therapy in several subsets of hypertensive patients, such as those with diabetes and nephropathy or with diminished left ventricular function with or without symptoms of heart failure 4.
• ACE inhibitors are considered an important option in most patients due to their safety profile, absence of adverse metabolic effects, and positive cardiac and renal effects 5.
• Combination therapy with two or more antihypertensive medications is often necessary to achieve effective control of blood pressure, and options include an ACE inhibitor/diuretic, an angiotensin-receptor blocker/diuretic, or a beta blocker/diuretic 6.
• Calcium channel blockers can be used in combination with beta-blockers or ACE inhibitors to achieve normotensive blood pressures, and this combination has been shown to be effective and well-tolerated in many patients 7.

Treatment Options

Treatment options for hypertension are numerous, and the selection of a specific combination drug regimen depends on various factors, including the patient's medical history and the presence of other health conditions.

• ACE inhibitors have been shown to be effective in reducing myocardial ischemia in hypertensive patients with coronary artery disease, but their use in normotensive patients with CAD and angina pectoris is limited due to the risk of aggravating angina 8.
• Calcium channel blockers can be used to reduce reinfarction in patients with ischemic heart disease, and long-acting formulas of CCBs can decrease congestive heart failure in patients with dilated cardiomyopathy and decrease strokes and arrhythmias in hypertensive subjects 4.