From the Guidelines
The most effective approach to managing hypertension involves a combination of lifestyle modifications and medication therapy, with lifestyle changes being the first line of treatment, as recommended by the most recent guidelines 1.
Lifestyle Modifications
Lifestyle changes should include:
- Reducing sodium intake to less than 2,300 mg/day
- Adopting a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern, rich in fruits, vegetables, and low-fat dairy products
- Moderating alcohol intake, with no more than 2 servings per day in men and no more than 1 serving per day in women
- Increasing physical activity levels
- Achieving and maintaining a healthy weight
Medication Therapy
When medications are needed, first-line options include:
- ACE inhibitors, such as lisinopril 10-40mg daily
- ARBs, such as losartan 25-100mg daily
- Thiazide diuretics, such as hydrochlorothiazide 12.5-25mg daily
- Calcium channel blockers, such as amlodipine 5-10mg daily Treatment typically begins with a single agent at a low dose, with adjustments based on blood pressure response. For stage 2 hypertension (BP ≥140/90 mmHg), combination therapy with two medications from different classes is often required, as supported by previous guidelines 1.
Monitoring and Adherence
Regular monitoring is essential, with a goal of achieving blood pressure below 130/80 mmHg for most adults. Medication adherence is crucial for successful management, and patients should be advised to take medications at the same time daily and report any side effects rather than discontinuing treatment. The use of internet or mobile-based digital platforms to reinforce healthy behaviors may be considered as a component of care, as these interventions have been found to enhance the efficacy of medical therapy for hypertension 1.
From the FDA Drug Label
Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions 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 may be administered alone or with other antihypertensive agents Amlodipine besylate tablets may be used alone or in combination with other antihypertensive agents.
The recommended treatment options for managing hypertension include:
- Monotherapy: Using a single antihypertensive drug, such as lisinopril or amlodipine, to lower blood pressure.
- Combination therapy: Using multiple antihypertensive drugs, such as lisinopril and amlodipine, to achieve blood pressure goals.
- Comprehensive cardiovascular risk management: Including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. It is essential to follow 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), for specific advice on goals and management 2 3.
From the Research
Treatment Options for Hypertension
The recommended treatment options for managing hypertension include:
- Lifestyle modification, consisting of weight loss, dietary sodium reduction and potassium supplementation, healthy dietary pattern, physical activity, and limited alcohol consumption 4, 5, 6, 7, 8
- First-line drug therapy for hypertension, which consists of a thiazide or thiazidelike diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 4
Lifestyle Modifications
Lifestyle modifications are a crucial part of hypertension management, and include:
- Maintaining a healthy body weight 5, 6, 7, 8
- Moderating consumption of alcohol 5, 6, 8
- Exercising regularly 5, 6, 7, 8
- Reducing sodium intake 5, 6, 7
- Altering intake of calcium, magnesium, and potassium 5
- Reducing stress 5
Drug Therapy
Drug therapy is often necessary to control hypertension, and the choice of medication depends on the individual's specific needs and medical history. The first-line medications for hypertension include:
- Thiazide or thiazidelike diuretics, such as hydrochlorothiazide or chlorthalidone 4
- Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, such as enalapril or candesartan 4
- Calcium channel blockers, such as amlodipine 4
Blood Pressure Targets
The goal of hypertension treatment is to achieve a blood pressure target of: