From the Guidelines
The initial treatment plan for hypertension should always begin with lifestyle modifications, including weight loss, a Dietary Approaches to Stop Hypertension (DASH)-style diet, moderation of alcohol intake, and increased physical activity, as outlined in the 2019 standards of medical care in diabetes 1.
Key Lifestyle Modifications
- Weight loss if overweight or obese
- Adoption of a DASH-style dietary pattern
- Reduction of sodium intake and increase of potassium intake
- Moderation of alcohol consumption
- Increased physical activity
Medication Therapy
If lifestyle modifications are insufficient to control blood pressure, medication therapy is indicated. First-line medications for hypertension include ACE inhibitors, ARBs, thiazide-like diuretics, or dihydropyridine calcium channel blockers, with the choice of initial medication depending on patient characteristics such as the presence of diabetes or albuminuria 1.
- ACE inhibitors (e.g., lisinopril) are recommended for patients with albuminuria or diabetes
- ARBs (e.g., losartan) are alternative options for patients who cannot tolerate ACE inhibitors
- Thiazide-like diuretics or dihydropyridine calcium channel blockers may be used in patients without albuminuria or diabetes
Monitoring and Follow-Up
Regular monitoring of blood pressure, serum creatinine, and potassium levels is essential to adjust treatment as needed and minimize the risk of adverse effects 1.
- Serum creatinine and estimated glomerular filtration rate should be monitored at least annually in patients treated with ACE inhibitors, ARBs, or diuretics
- Potassium levels should also be monitored regularly to prevent hyperkalemia
From the FDA Drug Label
Initial Therapy in adults: The recommended initial dose is 10 mg once a day. Dosage should be adjusted according to blood pressure response. The usual dosage range is 20 mg to 40 mg per day administered in a single daily dose. Use with diuretics in adults If blood pressure is not controlled with lisinopril alone, a low dose of a diuretic may be added (e.g., hydrochlorothiazide, 12. 5 mg). After the addition of a diuretic, it may be possible to reduce the dose of lisinopril. The recommended starting dose in adult patients with hypertension taking diuretics is 5 mg once per day.
The initial treatment plan for hypertension is to start with a dose of 10 mg of lisinopril once a day, with the option to adjust the dosage based on blood pressure response. The usual dosage range is 20 mg to 40 mg per day. If blood pressure is not controlled, a diuretic may be added, and the dose of lisinopril may be reduced. 2
- Key points:
- Initial dose: 10 mg once a day
- Usual dosage range: 20 mg to 40 mg per day
- Option to add a diuretic if blood pressure is not controlled
- Dose adjustment based on blood pressure response
From the Research
Initial Treatment Plan for Hypertension
The initial treatment plan for hypertension typically involves a combination of lifestyle changes and, if necessary, medication.
- Lifestyle changes:
- Weight loss in overweight persons 3
- Increased physical activity 3, 4
- Moderation of alcohol intake 3, 4
- Consumption of a diet that is higher in fruits, vegetables, and low-fat dairy products and lower in sodium content than the average American diet 3
- Reducing sodium intake 4, 5
- Altering intake of calcium, magnesium, and potassium 4
- Reducing stress 4
- Medication:
- Thiazide diuretics, such as chlortalidone or hydrochlorothiazide, are often recommended as the first-line treatment for hypertension 6, 7
- Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril, may also be used as an alternative to thiazide diuretics 6, 7
- Calcium channel blockers, such as amlodipine, may be used in certain cases, but are not typically recommended as the first-line treatment 7
Benefits of Lifestyle Changes
Lifestyle changes can have a significant impact on blood pressure and can be sustained over long periods of time.
- Weight loss, increased physical activity, and dietary changes can reduce the incidence of hypertension and lower blood pressure 3, 4, 5
- Reducing sodium intake and altering intake of calcium, magnesium, and potassium can also help to lower blood pressure 4, 5
- Stress reduction can also have a positive impact on blood pressure 4
Importance of Early Treatment
Early treatment of hypertension is crucial to prevent complications such as cardiovascular disease, stroke, and kidney disease.