From the Guidelines
Hypertension diagnosis and treatment should prioritize lifestyle modifications and pharmacological therapy to achieve blood pressure goals, with a focus on individualized treatment based on comorbidities and regular monitoring to reduce the risk of heart disease, stroke, kidney damage, and other complications. The diagnosis of hypertension is typically defined as readings consistently at or above 130/80 mmHg.
- Lifestyle modifications are essential in treating hypertension and include:
- Reducing sodium intake to less than 2,300 mg daily
- Adopting the DASH diet rich in fruits and vegetables
- Regular physical activity (150 minutes of moderate exercise weekly)
- Limiting alcohol consumption
- Maintaining a healthy weight
- Pharmacological management should be individualized based on comorbidities, with first-line medications including:
- Thiazide diuretics (hydrochlorothiazide 12.5-25 mg daily)
- ACE inhibitors (lisinopril 10-40 mg daily)
- ARBs (losartan 50-100 mg daily)
- Calcium channel blockers (amlodipine 5-10 mg daily) According to the most recent study 1, treatment of elevated blood pressure should focus on lifestyle modification, with pharmacotherapy considered if necessary.
- Blood pressure goals should generally be below 130/80 mmHg for most adults, though targets may be adjusted for elderly patients.
- Regular monitoring is essential, ideally with home blood pressure measurements taken at the same time daily. The American Heart Association recommends that patients with heart failure should be treated with diuretics, ACE inhibitors (or ARBs), β-blockers, and aldosterone receptor antagonists 1.
- Medication adherence is crucial for successful blood pressure control, and patients should understand that treatment is typically lifelong. It is also important to consider the potential risks and benefits of different medications, as well as the patient's individual needs and preferences, when developing a treatment plan.
- For example, ACE inhibitors are preferred for patients with diabetes or heart failure, while calcium channel blockers may be preferred for patients with certain comorbidities. Overall, the key to effective hypertension management is a comprehensive approach that incorporates lifestyle modifications, pharmacological therapy, and regular monitoring to reduce the risk of complications and improve patient outcomes.
From the FDA Drug Label
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. Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake Many patients will require more than 1 drug to achieve blood pressure goals. 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 diagnosis of Hypertension (High Blood Pressure) is not explicitly stated in the provided drug labels, but it can be inferred that it is characterized by elevated systolic or diastolic pressure. The treatment for Hypertension (High Blood Pressure) includes:
- Lisinopril to lower blood pressure and reduce the risk of fatal and non-fatal cardiovascular events
- Amlodipine besylate to relax blood vessels and lower blood pressure
- Comprehensive cardiovascular risk management, including:
- Lipid control
- Diabetes management
- Antithrombotic therapy
- Smoking cessation
- Exercise
- Limited sodium intake It is recommended to follow published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC), for specific advice on goals and management 2.
From the Research
Diagnosis of Hypertension
- Hypertension is defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg 3
- Elevated blood pressure is associated with an increased risk of heart failure, myocardial infarction, cerebrovascular disease, and death 4
Treatment of Hypertension
- First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 3, 5, 6
- Lifestyle modifications that can help lower blood pressure include:
- First-line drug therapy for hypertension consists of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 3, 4, 7
- The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk 3
- The goal of treatment is to achieve a blood pressure target of less than 130/80 mm Hg for adults under 65 years and less than 130 mm Hg for adults 65 years and older 3
Combination Therapy
- More than 70% of adults treated for primary hypertension will eventually require at least two antihypertensive agents 7
- Four main classes of medications are used in combination therapy for the treatment of hypertension: thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers 7
- ACEIs and ARBs should not be used simultaneously 7
- Patients with heart failure with reduced ejection fraction should be treated initially with a beta blocker and an ACEI or ARB, followed by add-on therapy with a mineralocorticoid receptor antagonist and a diuretic based on volume status 7