What medication is prescribed for diastolic hypertension?

First-Line Medications for Diastolic Hypertension

For patients with diastolic hypertension, ACE inhibitors should be considered as first-line therapy, with thiazide diuretics and beta-blockers as additional effective options. 1

Initial Treatment Approach

• ACE inhibitors are recommended as first-line agents for most patients with diastolic hypertension due to their effectiveness in reducing cardiovascular events and mortality 1, 2
• Thiazide-type diuretics are also appropriate first-line agents, either alone or in combination with other medications, particularly for uncomplicated hypertension 1
• Beta-blockers have shown significant benefit in reducing cardiovascular morbidity and mortality in patients with diastolic hypertension 1

Medication Selection Algorithm

First-line options:

• ACE inhibitors (e.g., lisinopril): Particularly beneficial for patients with diabetes, microalbuminuria, or clinical nephropathy 1, 3
• Thiazide diuretics: Effective in reducing blood pressure and cardiovascular events, especially in uncomplicated hypertension 1, 2
• ARBs (Angiotensin Receptor Blockers): Can be used if ACE inhibitors are not tolerated 1

Second-line options:

• Calcium channel blockers: Particularly dihydropyridine CCBs (e.g., amlodipine) which can be added when first-line agents are insufficient 1, 4
• Combination therapy: Consider when blood pressure is >20/10 mmHg above target 1, 4

Treatment Targets

• The goal for patients with diastolic hypertension should be a blood pressure below 130/80 mmHg 1
• For patients with diabetes, the target remains 130/80 mmHg 1
• Initial treatment with lifestyle/behavioral therapy alone is appropriate for patients with diastolic BP of 80-89 mmHg, but only for a maximum of 3 months before initiating pharmacologic therapy if targets are not achieved 1

Special Considerations

• In elderly patients with isolated systolic hypertension, dihydropyridine calcium channel blockers or ARBs may be preferred as they have less impact on diastolic pressure 5
• For patients with diastolic dysfunction (common in hypertension), ACE inhibitors and ARBs have shown efficacy in improving measures of diastolic function 6
• Combination therapy with an ACE inhibitor and calcium channel blocker has shown good efficacy and tolerability, particularly in patients with high cardiovascular risk 7, 8

Common Pitfalls to Avoid

• Failing to intensify treatment when blood pressure remains uncontrolled (therapeutic inertia) 9
• Overlooking the benefits of single-pill combinations for improving adherence in patients requiring multiple medications 9
• Excessive blood pressure lowering in elderly patients, which may cause orthostatic symptoms 9
• Neglecting to monitor for orthostatic hypotension when initiating or adjusting therapy, particularly in elderly patients 9

Monitoring Recommendations

• Follow up within 2-4 weeks after medication changes to assess efficacy and adverse effects 9
• Monitor renal function and serum potassium levels when using ACE inhibitors or ARBs 1
• Consider home blood pressure monitoring to better assess treatment efficacy 9

Remember that many patients will require three or more drugs to achieve target blood pressure, and the achievement of the target with minimal side effects is more important than the specific drug strategy 1.