What is the recommended treatment for a 45-year-old male with hypertension?

Hypertension Treatment for a 45-Year-Old Male

For a 45-year-old male with hypertension, first-line pharmacological treatment should include an ACE inhibitor such as lisinopril, along with lifestyle modifications. 1

Initial Assessment and Classification

Before initiating treatment, determine the severity of hypertension:

• Stage 1 Hypertension: 130-139 mmHg systolic or 80-89 mmHg diastolic
• Stage 2 Hypertension: ≥140 mmHg systolic or ≥90 mmHg diastolic 1

Treatment Algorithm

Step 1: Lifestyle Modifications (for all patients)

Lifestyle modifications are the foundation of hypertension management and should be implemented regardless of pharmacological treatment:

• Weight loss if overweight (aim for ideal body weight)
• DASH diet (Dietary Approaches to Stop Hypertension)
• Sodium restriction (<2,300 mg/day)
• Increased physical activity (at least 150 minutes of moderate-intensity exercise per week)
• Alcohol moderation (≤2 drinks/day for men)
• Smoking cessation 2, 1, 3

Step 2: Pharmacological Treatment

For a 45-year-old male, the recommended first-line medication is:

• ACE inhibitor (e.g., lisinopril) 1, 4

This recommendation is based on the American College of Cardiology guidelines that suggest ACE inhibitors or ARBs as preferred first-line agents for patients less than 55 years old 1.

If blood pressure remains uncontrolled with a single agent:

• Add a calcium channel blocker (e.g., amlodipine) as second-line therapy 1, 5
• Add a thiazide-like diuretic (e.g., chlorthalidone) as third-line therapy if needed 2

Special Considerations

For Specific Comorbidities

• If albuminuria is present: ACE inhibitor or ARB is strongly recommended 2
• If coronary artery disease is present: ACE inhibitor or ARB is recommended first-line 2
• If reduced renal function: Consider a calcium channel blocker as they maintain efficacy even with reduced GFR 1

Blood Pressure Targets

• Target BP: <130/80 mmHg 1
• For patients with high cardiovascular risk, achieving this target is particularly important to reduce risk of stroke and cardiac events 2

Monitoring and Follow-up

• Monitor serum creatinine and potassium levels 7-14 days after initiation or dose change of ACE inhibitors or ARBs 2
• Monitor for hypokalemia when diuretics are used 2
• Regular BP monitoring both in-office and at home to detect white coat or masked hypertension 2

Important Caveats

• ACE inhibitors and ARBs are contraindicated in pregnancy and should be avoided in sexually active women of childbearing potential who are not using reliable contraception 2
• If the patient is of Black ethnicity, calcium channel blockers or thiazide diuretics may be more effective as first-line agents 1
• For patients with blood pressure ≥150/90 mmHg, consider initiating treatment with two antihypertensive medications 2

By following this treatment approach, you can effectively manage hypertension in your 45-year-old male patient, reducing his risk of cardiovascular events, stroke, and mortality.