What are the best specific medication names for elevated diastolic blood pressure (hypertension)?

From the Guidelines

For elevated diastolic blood pressure, thiazide diuretics like chlorthalidone (12.5-25mg daily) or hydrochlorothiazide (12.5-50mg daily) are often recommended as first-line treatments, as supported by the most recent guidelines 1.

Recommended Medications

• Angiotensin-converting enzyme (ACE) inhibitors such as lisinopril (10-40mg daily) or enalapril (5-40mg daily) are also effective, particularly for patients with diabetes or kidney disease.
• Angiotensin II receptor blockers (ARBs) like losartan (25-100mg daily) or valsartan (80-320mg daily) offer similar benefits with fewer side effects than ACE inhibitors.
• Calcium channel blockers such as amlodipine (2.5-10mg daily) or diltiazem extended-release (120-540mg daily) work well, especially in older patients and African Americans.
• Beta-blockers like metoprolol succinate (25-200mg daily) may be added if other medications aren't sufficient.

Treatment Approach

• Treatment should start with a low dose of a single medication, increasing gradually if needed, with potential combination therapy for resistant hypertension.
• Lifestyle modifications including reduced sodium intake, regular exercise, weight management, limited alcohol consumption, and stress reduction are essential companions to medication.
• These medications work through different mechanisms—diuretics reduce blood volume, ACE inhibitors and ARBs relax blood vessels, calcium channel blockers prevent vessel constriction, and beta-blockers reduce heart rate and output—all contributing to lower diastolic pressure.

Combination Therapy

• The combination of a thiazide diuretic, an ACE inhibitor or ARB, and a calcium channel blocker is often recommended for patients who require multiple medications to control their blood pressure 1.
• The use of single-pill combinations is preferred to improve adherence and reduce side effects.
• The addition of spironolactone or other mineralocorticoid receptor antagonists may be considered for patients with resistant hypertension.

From the FDA Drug Label

Losartan is indicated for the treatment of hypertension in adult patients 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. Diuretics such as chlorthalidone are indicated in the management of hypertension either as the sole therapeutic agent or to enhance the effect of other antihypertensive drugs in the more severe forms of hypertension.

The best specific medication names for elevated diastolic blood pressure (hypertension) are:

• Losartan
• Lisinopril
• Chlorthalidone 2, 3, 4

From the Research

Medications for Elevated Diastolic Blood Pressure

The following medications have been studied for their effectiveness in treating elevated diastolic blood pressure:

• Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to be effective in improving measures of diastolic function and are recommended as first-line agents in the control of hypertension in patients with diastolic heart failure 5
• Beta-blockers, calcium channel blockers, and diuretics have also shown some efficacy in improved indices of diastolic filling 5
• Thiazide diuretics, calcium channel blockers, ACEIs, and ARBs are used in combination therapy for the treatment of hypertension 6
• Specific medication combinations that have been studied include:
  • Amlodipine/Losartan and Chlorthalidone 7
  • Metoprolol extended release/amlodipine 8
  • Losartan plus amlodipine 8
• Individual medications that have been studied include:
  • Lisinopril, which was found to be effective and safe in the treatment of mild to moderate essential hypertension, with fewer adverse events compared to metoprolol 9
  • Metoprolol, which was found to be effective in reducing blood pressure, but with more adverse events compared to lisinopril 9

Combination Therapy

Combination therapy is often used to treat hypertension, as it can be more effective than monotherapy:

• The use of two or more antihypertensive agents can be more effective than high-dose monotherapy 7
• Combination therapy can include ACEIs, ARBs, calcium channel blockers, and thiazide diuretics 6
• Specific combination therapies that have been studied include:
  • Amlodipine/Losartan and Chlorthalidone, which was found to be equivalent to individual tablets in a loose combination 7
  • Metoprolol extended release/amlodipine, which was found to be as effective and well tolerated as losartan plus amlodipine 8