What are the treatment options for hypertension?

From the Guidelines

Hypertension treatment should begin with lifestyle modifications, including weight loss, a Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern, moderation of alcohol intake, and increased physical activity, as these interventions lower blood pressure, enhance the effectiveness of antihypertensive medications, and promote overall metabolic and vascular health with few adverse effects 1.

Lifestyle Modifications

• Weight loss if overweight or obese
• DASH-style dietary pattern, including reducing sodium intake to < 2,300 mg/day and increasing potassium intake
• Moderation of alcohol intake, with no more than 2 servings per day in men and no more than 1 serving per day in women
• Increased physical activity

Medication Therapy

If lifestyle modifications are insufficient, medication therapy should be initiated, with first-line medications including:

• Thiazide diuretics, such as hydrochlorothiazide 12.5-25mg daily
• ACE inhibitors, such as lisinopril 10-40mg daily
• ARBs, such as losartan 25-100mg daily
• Calcium channel blockers, such as amlodipine 5-10mg daily Treatment goals should aim for blood pressure below 130/80 mmHg for most adults, though targets may vary based on age and comorbidities, and combination therapy is often necessary to achieve these goals 1.

Monitoring and Adherence

Regular monitoring is essential, with home blood pressure measurements complementing clinical assessments, and medication adherence is crucial for success, as hypertension is typically a lifelong condition requiring consistent management.

• Serum creatinine/estimated glomerular filtration rate and serum potassium levels should be monitored at least annually in patients treated with an ACE inhibitor, angiotensin receptor blocker, or diuretic 1.

From the FDA Drug Label

Many patients will require more than 1 drug to achieve blood pressure goals. Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits Losartan may be administered with other antihypertensive agents. Lisinopril tablets USP may be administered alone or with other antihypertensive agents

The treatment options for hypertension include:

• Monotherapy: using a single antihypertensive drug, such as losartan 2 or lisinopril 3
• Combination therapy: using multiple antihypertensive drugs, such as losartan 2 or lisinopril 3 with other agents, to achieve blood pressure goals
• Comprehensive cardiovascular risk management: including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake 2 3

From the Research

Treatment Options for Hypertension

The treatment options for hypertension can be categorized into lifestyle modifications and pharmacological interventions.

• Lifestyle modifications:
  • Diet adaptation, such as the Dietary Approaches to Stop Hypertension (DASH) diet 4, 5, 6
  • Sodium reduction 4, 5, 7, 6
  • Alcohol restriction 4, 5, 7, 6
  • Physical exercise 4, 5, 7, 6
  • Weight reduction 4, 5, 7, 6
  • Potassium supplementation 5, 7
  • Smoking cessation 4
  • Stress management 4, 7

Pharmacological Interventions

• First-line drug therapy for hypertension consists of:
  • Thiazide or thiazide-like diuretics, such as hydrochlorothiazide or chlorthalidone 5, 6, 8
  • Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, such as enalapril or candesartan 5, 6, 8
  • Calcium channel blockers, such as amlodipine 5, 6, 8
• Combination therapy with Losartan, Amlodipine, and Hydrochlorothiazide may be effective in managing stage 2 hypertension 8

Blood Pressure Targets

• The recommended blood pressure target is less than 130/80 mmHg for adults under 65 years and less than 130 mmHg for adults over 65 years 5
• A blood pressure goal of less than 140/90 mmHg is recommended in patients with chronic kidney disease and in those with diabetes mellitus 6