From the Guidelines
For the management of hypertensive disease, I strongly recommend initiating treatment with a combination of two first-line agents, preferably a RAS blocker (either an ACE inhibitor or an ARB) with a dihydropyridine CCB or diuretic, as this approach has been shown to effectively reduce blood pressure and cardiovascular disease events 1.
First-Line Treatment Options
The following medications are recommended as first-line treatments for hypertension:
- ACE inhibitors
- ARBs
- Dihydropyridine CCBs
- Diuretics (thiazides and thiazide-like drugs such as chlorthalidone and indapamide) These medications have demonstrated the most effective reduction of blood pressure and cardiovascular disease events, and are therefore recommended as initial therapy 1.
Combination Therapy
Combination therapy is recommended for most patients with confirmed hypertension (BP ≥140/90 mmHg) as initial therapy, with preferred combinations being a RAS blocker with a dihydropyridine CCB or diuretic 1.
Dose and Administration
Fixed-dose single-pill combination treatment is recommended for patients receiving combination BP-lowering treatment, as it can improve adherence and reduce side effects 1.
Treatment Escalation
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.
Additional Treatment Options
If blood pressure is not controlled with a three-drug combination, adding spironolactone should be considered, followed by eplerenone or other mineralocorticoid receptor antagonists (MRAs) if spironolactone is not effective or tolerated 1.
Beta-Blockers
Beta-blockers are recommended to be combined with any of the other major BP-lowering drug classes when there are other compelling indications for their use, such as angina, post-myocardial infarction, heart failure with reduced ejection fraction, or for heart rate control 1.
From the FDA Drug Label
1 INDICATIONS & USAGE 1. 1 Hypertension Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure.
Amlodipine besylate is a type of medicine known as a calcium channel blocker (CCB). It is used to treat high blood pressure (hypertension) and a type of chest pain called angina.
The medication for Hypertensive (High Blood Pressure) Disease is:
- Amlodipine besylate tablets 2, 2 It can be used alone or in combination with other antihypertensive agents to treat high blood pressure. Key points:
- Amlodipine besylate tablets are indicated for the treatment of hypertension
- It can be used alone or in combination with other antihypertensive agents
- The goal is to lower blood pressure and reduce the risk of fatal and nonfatal cardiovascular events.
From the Research
Medications for Hypertensive Disease
The following medications are used to treat hypertensive disease in patients undergoing hemodialysis:
- Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are first-line antihypertensive agents due to their safety profile and demonstrated benefit on cardiovascular outcomes in clinical trials 3, 4, 5
- Beta-blockers are effective in decreasing mortality, blood pressure, and ventricular arrhythmias, and improving left ventricular function in end-stage renal disease (ESRD) patients 4, 6
- Calcium channel blockers are associated with lower total and cardiovascular-specific mortality in hemodialysis patients 4, 6
- Direct vasodilators, such as minoxidil, are very potent and generally reserved for dialysis patients with severe hypertension 4
- Direct renin inhibitors may provide alternative options to improve blood pressure, but require testing for efficacy and safety in hemodialysis patients 3
- Mineralocorticoid-receptor-antagonists (MRAs) may reduce cardiovascular mortality, but the associated risk of hyperkalemia raises important safety concerns 5
Administration and Dosage
- Many blood pressure agents can be dosed once daily and should preferentially be administered at night to control nocturnal blood pressure and minimize intradialytic hypotension 3
- Renally eliminated agents, such as lisinopril and atenolol, can be given thrice weekly following hemodialysis in patients who are noncompliant with therapy 3, 4, 7
- Long-acting dihydropyridines and ACEIs/ARBs are second-line and third-line choices, respectively, for the treatment of hypertension in hemodialysis patients 5