From the Guidelines
For a Caucasian patient with newly diagnosed hypertension and normal kidney function, an ACE inhibitor such as lisinopril 10 mg daily is the best initial medication choice, as recommended by the 2020 international society of hypertension global hypertension practice guidelines 1.
Initial Medication Choice
The choice of initial medication for hypertension in a Caucasian patient with normal kidney function should be guided by the most recent and highest quality evidence. According to the 2020 international society of hypertension global hypertension practice guidelines 1, the first step in drug therapy for non-Black patients is a low dose ACEI/ARB.
Alternative Options
Alternative options may include a dihydropyridine calcium channel blocker (DHP-CCB) or a thiazide-like diuretic, as recommended by the guidelines 1. However, an ACE inhibitor is the preferred initial choice due to its effectiveness in reducing blood pressure and its protective effects on the kidneys.
Dosing and Titration
The initial dose of lisinopril should be 10 mg daily, and the patient's blood pressure should be reassessed in 2-4 weeks. If the target blood pressure is not reached, the dose can be titrated upward to achieve optimal control.
Lifestyle Modifications
In addition to medication therapy, lifestyle modifications such as reduced sodium intake, regular exercise, weight management, and limited alcohol consumption should be encouraged to achieve optimal blood pressure control and reduce cardiovascular risk.
Evidence-Based Recommendation
The recommendation to use an ACE inhibitor as the initial medication for hypertension in a Caucasian patient with normal kidney function is based on the most recent and highest quality evidence available 1. This guideline provides a simple and effective approach to managing hypertension and reducing cardiovascular risk.
Key Points
- ACE inhibitor is the preferred initial medication choice for hypertension in Caucasian patients with normal kidney function 1.
- Initial dose of lisinopril should be 10 mg daily.
- Lifestyle modifications should accompany medication therapy to achieve optimal results.
- The 2020 international society of hypertension global hypertension practice guidelines provide a comprehensive approach to managing hypertension and reducing cardiovascular risk 1.
From the FDA Drug Label
Lisinopril demonstrated superior reductions of systolic and diastolic compared to hydrochlorothiazide in a population that was 75% Caucasian Lisinopril was approximately equivalent to atenolol and metoprolol in reducing diastolic blood pressure, and had somewhat greater effects on systolic blood pressure.
The best initial medication to start for new onset hypertension in a Caucasian patient with normal renal function is lisinopril.
- Key points:
- Lisinopril has been shown to be effective in reducing blood pressure in Caucasian patients.
- It has a similar effect to atenolol and metoprolol in reducing diastolic blood pressure.
- Lisinopril is generally well-tolerated and has a low risk of adverse effects. 2
From the Research
Initial Medication for New Onset Hypertension
- For a Caucasian patient with normal renal function, the best initial medication for new onset hypertension can be determined based on various studies 3, 4, 5, 6, 7.
- According to the study published in Prescrire international 5, the first-choice treatment for hypertension in nondiabetic adults without cardiovascular or renal disease should be a thiazide diuretic, such as chlortalidone or hydrochlorothiazide.
- Another study published in the Journal of hypertension 4 found that the combination of amlodipine and lisinopril had a marked additional effect on blood pressure compared to either medication alone, but this was not specifically recommended as the initial treatment.
- The American family physician study 3 suggests that four main classes of medications are used in combination therapy for the treatment of hypertension: thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs).
- The Postgraduate medical journal study 6 found that the combination of amlodipine and lisinopril produced a significant additional blood pressure lowering effect compared to either medication alone, but again, this was not specifically recommended as the initial treatment.
Recommended Initial Medication
- Based on the available evidence, a thiazide diuretic such as chlortalidone or hydrochlorothiazide is recommended as the initial medication for new onset hypertension in a Caucasian patient with normal renal function 5.
- If a thiazide diuretic is not available or cannot be used, an ACE inhibitor such as lisinopril may be considered as an alternative 5.