What medications are used to treat hypertensive heart disease?

From the Guidelines

Medications used to treat hypertensive heart disease typically include ACE inhibitors, ARBs, beta-blockers, diuretics, and aldosterone antagonists, with the goal of reducing blood pressure and improving cardiac function, as recommended by the most recent guidelines 1. The treatment of hypertensive heart disease involves a combination of lifestyle modifications and pharmacological interventions.

• First-line treatments often include angiotensin-converting enzyme (ACE) inhibitors like lisinopril (10-40 mg daily) or enalapril (5-40 mg daily), which reduce blood pressure and protect the heart by blocking the renin-angiotensin system, as supported by studies 1.
• Angiotensin II receptor blockers (ARBs) such as losartan (25-100 mg daily) or valsartan (80-320 mg daily) work similarly and are good alternatives for patients who develop a cough with ACE inhibitors.
• Beta-blockers like metoprolol (25-200 mg daily) or carvedilol (3.125-25 mg twice daily) reduce heart rate and cardiac workload, particularly beneficial for patients with heart failure symptoms.
• Diuretics like hydrochlorothiazide (12.5-25 mg daily) or furosemide (20-80 mg daily) reduce fluid volume and are often combined with other medications.
• For advanced disease, aldosterone antagonists like spironolactone (25-50 mg daily) may be added, as recommended by the American College of Cardiology and American Heart Association guidelines 1. The choice of medication depends on the individual patient's comorbidities and the presence of other cardiovascular risk factors, with the goal of achieving a target blood pressure below 130/80 mmHg, as recommended by the most recent guidelines 1.
• Combination therapy is often necessary to achieve this goal, and may include agents with complementary mechanisms of action, such as ACE inhibitors, ARBs, beta-blockers, and diuretics.
• The use of single-pill combinations can improve adherence, but may contain lower-than-optimal doses of certain medications, such as thiazide diuretics.
• Regular monitoring of blood pressure, kidney function, and electrolytes is necessary to adjust medication regimens and minimize potential side effects, as supported by studies 1.

From the FDA Drug Label

Lisinopril tablets, USP, are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. 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 The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly

The medications used to treat hypertensive heart disease include:

• Lisinopril: an angiotensin-converting enzyme (ACE) inhibitor, which is indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure.
• Other antihypertensive drugs from a variety of pharmacologic classes, which have been shown to reduce cardiovascular morbidity and mortality. These medications can help reduce the risk of stroke, myocardial infarction, and cardiovascular mortality associated with hypertensive heart disease 2.

From the Research

Medications for Hypertensive Heart Disease

The following medications are used to treat hypertensive heart disease:

• Angiotensin-converting enzyme (ACE) inhibitors, which have been shown to provide survival benefits for patients with heart failure, proteinuric chronic kidney disease, and/or a high cardiac risk profile 3
• Angiotensin receptor blockers (ARBs), which may be used in combination with ACE inhibitors, although the benefits of this combination are still being studied 3
• Calcium channel blockers (CCBs), which appear to reduce reinfarction in patients with ischemic heart disease and decrease congestive heart failure in patients with dilated cardiomyopathy 4
• Diuretics, such as thiazide diuretics, which are often used as first-line therapy for hypertension and have been shown to reduce all-cause mortality in hypertensive patients 5
• Beta-blockers, which may be used in certain situations, although they are not generally considered first-line therapy for hypertension 5

Specific Medications

Some specific medications that may be used to treat hypertensive heart disease include:

• Amlodipine, a calcium channel blocker that has been shown to be effective in lowering blood pressure when used alone or in combination with an ACE inhibitor 6
• Lisinopril, an ACE inhibitor that has been shown to be effective in lowering blood pressure and reducing the risk of heart failure 6
• Chlortalidone, a thiazide diuretic that has been shown to be effective in reducing all-cause mortality in hypertensive patients and is often considered first-line therapy for hypertension 5
• Hydrochlorothiazide, another thiazide diuretic that may be used as an alternative to chlortalidone 5

Combination Therapy

Combination therapy, such as the use of an ACE inhibitor and a calcium channel blocker, may be effective in lowering blood pressure and reducing the risk of heart failure 6. However, the benefits and risks of combination therapy should be carefully considered and individualized for each patient 3.