What medication is used to target elevated diastolic blood pressure (hypertension)?

Medications for Targeting Diastolic Hypertension

For patients with elevated diastolic blood pressure, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) should be considered as first-line therapy, with calcium channel blockers (CCBs) as effective alternatives. 1, 2

First-Line Medication Options

ACE Inhibitors/ARBs

• Most effective for diastolic hypertension control
• Shown to improve measures of diastolic function 1
• Examples: lisinopril, losartan
• Losartan is indicated for hypertension in adults to lower blood pressure 3
• Monitor renal function and potassium levels within 1-2 weeks of initiation 4

Calcium Channel Blockers (CCBs)

• Particularly effective for diastolic BP reduction
• Amlodipine is indicated for treatment of hypertension 5
• Can be used alone or in combination with other antihypertensive agents
• Non-dihydropyridine CCBs (verapamil, diltiazem) may have additional benefits in reducing coronary events 2

Second-Line and Combination Options

Thiazide Diuretics

• Recommended as part of combination therapy
• Particularly effective when combined with ACE inhibitors/ARBs 2
• Enhance antihypertensive efficacy of multidrug regimens 2

Beta-Blockers

• Consider as add-on therapy when diastolic BP remains elevated
• Particularly beneficial in patients with coronary artery disease
• Can be added as a fourth agent when BP remains uncontrolled on a three-drug regimen 4

Treatment Algorithm

1. Initial therapy: Start with ACE inhibitor/ARB (e.g., lisinopril 10-20 mg daily or losartan 50 mg daily) 6, 3

2. If target not achieved (diastolic BP <80 mmHg):

   • Add CCB (e.g., amlodipine 5-10 mg daily) 5, 2

3. If still not at target:

   • Add thiazide diuretic to create a three-drug combination 2

4. For resistant hypertension:

   • Add spironolactone (if tolerated) or beta-blocker 2

Target Blood Pressure Goals

• For most adults: diastolic BP <80 mmHg 2
• For older adults (≥65 years): diastolic BP 70-79 mmHg 2, 4
• For patients with diabetes or chronic kidney disease: diastolic BP <80 mmHg 2

Important Considerations

• Diastolic hypertension is present in approximately half of all hypertensive patients and is associated with increased cardiovascular morbidity and mortality 1
• Most patients will require more than one medication to achieve target blood pressure 2, 7
• When using ACE inhibitors or ARBs, monitor renal function and serum potassium levels 2, 4
• Combination therapy should be used cautiously in those at risk for orthostatic hypotension 2
• For patients with diastolic BP 80-89 mmHg, lifestyle modifications should be tried for a maximum of 3 months before initiating pharmacotherapy 2

Pitfalls to Avoid

• Avoid rapid titration in elderly patients, which may lead to orthostatic hypotension
• Don't use thiazide diuretics if CrCl <30 mL/min; consider loop diuretics instead 4
• Avoid combining spironolactone with ARBs without careful monitoring of potassium levels 4
• Don't discontinue medications without specific clinical indications, as this can lead to worsening BP control 4

By following this evidence-based approach to medication selection for diastolic hypertension, clinicians can effectively reduce cardiovascular risk and improve patient outcomes.