What is the treatment for newly diagnosed hypertension?

From the Guidelines

For newly diagnosed hypertension, lifestyle modifications should be initiated first, including reduced sodium intake, regular exercise, weight loss if overweight, limited alcohol consumption, and a DASH diet rich in fruits and vegetables, as recommended by the most recent guidelines 1. The goal of these lifestyle interventions is to lower blood pressure, enhance the effectiveness of some antihypertensive medications, promote other aspects of metabolic and vascular health, and generally lead to few adverse effects. Some key components of lifestyle therapy include:

• Reducing excess body weight through caloric restriction
• Restricting sodium intake to less than 2,300 mg/day
• Increasing consumption of fruits and vegetables to 8-10 servings per day
• Increasing consumption of low-fat dairy products to 2-3 servings per day
• Avoiding excessive alcohol consumption, with no more than 2 servings per day in men and no more than 1 serving per day in women
• Increasing activity levels If blood pressure remains ≥140/90 mmHg despite these changes, medication therapy is recommended, with first-line medications including thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers, as supported by previous guidelines 1. The choice of medication depends on patient characteristics, such as the presence of diabetes or kidney disease, which may prefer ACE inhibitors, or elderly patients, who may benefit from calcium channel blockers. It is essential to start with a low dose and titrate upward every 2-4 weeks until target blood pressure (<130/80 mmHg) is achieved, with regular monitoring, including home blood pressure measurements and follow-up appointments, as emphasized in earlier studies 1. If one medication is insufficient, a second agent from a different class should be added rather than maximizing the dose of a single drug, to effectively target different pathways of blood pressure regulation.

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. 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.

The treatment for newly diagnosed hypertension is to lower blood pressure using antihypertensive drugs such as losartan 2 or lisinopril 3.

• Control of high blood pressure should be part of comprehensive cardiovascular risk management.
• Many patients will require more than 1 drug to achieve blood pressure goals.
• For specific advice on goals and management, see 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).

From the Research

Treatment for Newly Diagnosed Hypertension

The treatment for newly diagnosed hypertension typically involves a combination of lifestyle modifications and medication.

• Lifestyle modifications include:
  • Weight loss
  • Healthy dietary pattern with low sodium and high potassium intake
  • Physical activity
  • Moderation or elimination of alcohol consumption 4
• First-line drug therapy for hypertension consists of:
  • A thiazide or thiazide-like diuretic
  • An angiotensin-converting enzyme inhibitor or angiotensin receptor blocker
  • A calcium channel blocker 4, 5, 6

Medication Therapy

Medication therapy is typically initiated based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk.

• The goal of medication therapy is to achieve a blood pressure target of less than 130/80 mm Hg for adults under 65 years and a systolic blood pressure of less than 130 mm Hg for adults 65 years and older 4
• Combination therapy with two or more antihypertensive agents may be required to achieve adequate blood pressure control, especially in patients with chronic kidney disease or diabetes mellitus 5, 7

Lifestyle Modifications

Lifestyle modifications are an essential part of hypertension management, and can help to lower blood pressure and reduce the risk of cardiovascular disease.

• A study conducted in Canada found that recently diagnosed hypertensive patients were more likely to make lifestyle modifications, such as smoking cessation and decreasing physical inactivity, although weight gain was a concern, especially among those taking antihypertensive medication 8
• The Dietary Approaches to Stop Hypertension diet, sodium restriction, regular exercise, and moderate weight loss have been shown to be effective in improving blood pressure 6