What is the best treatment for elevated ventricular systolic pressure (hypertension)?

From the Guidelines

The most effective treatment for elevated ventricular systolic pressure (hypertension) is a combination of an ACE inhibitor or an ARB with a dihydropyridine CCB or diuretic, as recommended by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. This approach is based on the strongest evidence available, which demonstrates that these combinations are effective in reducing blood pressure and cardiovascular disease events.

• The recommended first-line treatments include ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics, which have been shown to be effective in lowering blood pressure and reducing cardiovascular disease events 1.
• Beta-blockers can be combined with other BP-lowering drugs when there are compelling indications for their use, such as angina, post-myocardial infarction, heart failure with reduced ejection fraction, or for heart rate control 1.
• Fixed-dose single-pill combination treatment is recommended for patients receiving combination BP-lowering treatment, as it can improve adherence to medication regimens 1.
• If blood pressure is not controlled with a two-drug combination, increasing to a three-drug combination is recommended, usually a RAS blocker with a dihydropyridine CCB and a thiazide/thiazide-like diuretic, and preferably in a single-pill combination 1. The goal of treatment is to reduce blood pressure to a level that minimizes the risk of cardiovascular disease events, while also improving quality of life and reducing morbidity and mortality.
• Lifestyle modifications, such as reducing sodium intake, regular aerobic exercise, weight management, limiting alcohol consumption, and smoking cessation, are also important components of hypertension management and can help to lower blood pressure and reduce cardiovascular risk.

From the FDA Drug Label

Losartan is indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older, to lower blood pressure. Lowering blood pressure lowers the risk of fatal and nonfatal cardiovascular (CV) events, primarily strokes and myocardial infarction 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 best treatment for elevated ventricular systolic pressure (hypertension) is to lower blood pressure using antihypertensive drugs such as losartan.

• The goal is to reduce the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarction.
• Losartan may be administered with other antihypertensive agents to achieve blood pressure goals.
• The usual starting dose of losartan is 50 mg once daily, and the dosage can be increased to a maximum dose of 100 mg once daily as needed to control blood pressure 2.

From the Research

Treatment Options for Elevated Ventricular Systolic Pressure (Hypertension)

The treatment for elevated ventricular systolic pressure, or hypertension, typically involves a combination of lifestyle modifications and pharmacologic therapy.

• Lifestyle modification is considered first-line therapy for hypertension, including:
  • Weight loss
  • Healthy dietary pattern with low sodium and high potassium intake
  • Physical activity
  • Moderation or elimination of alcohol consumption 3, 4
• Pharmacologic therapy is initiated based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk.
• First-line drug therapy for hypertension consists of:
  • Thiazide or thiazide-like diuretics (e.g., hydrochlorothiazide or chlorthalidone)
  • Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (e.g., enalapril or candesartan)
  • Calcium channel blockers (e.g., amlodipine) 3, 5

Benefits of Treatment

• Randomized clinical trials have established the efficacy of blood pressure lowering to reduce the risk of cardiovascular disease morbidity and mortality 3, 5
• An systolic blood pressure reduction of 10 mm Hg decreases the risk of cardiovascular disease events by approximately 20% to 30% 3

Special Considerations

• In patients with systolic left ventricular dysfunction, angiotensin-converting enzyme inhibitors are the treatment of choice, with diuretics and digoxin added in patients with overt congestive heart failure 6
• Recent studies suggest that other drugs, such as carvedilol and losartan, may be beneficial in certain cases, but current evidence is still scarce 6