From the Guidelines
The first-line medication for hypertension is an ACE inhibitor or ARB, particularly in patients with diabetes and coronary artery disease.
Key Considerations
- In patients without a compelling indication for use of a specific drug, thiazide diuretics, calcium-channel blockers, ACE inhibitors, or angiotensin-receptor blockers are recommended as first-line therapy 1.
- ACE inhibitors/ARBs are preferred in patients with diabetes and coronary artery disease due to their ability to reduce the progression of kidney disease and the risk of atherosclerotic ischemic events 1.
- Thiazide diuretics and calcium-channel blockers are recommended as first-line agents in black patients, including those with diabetes mellitus 1.
- The choice of antihypertensive agent should be based on the patient's individual characteristics, such as the presence of comorbidities, and the potential benefits and risks of each medication 1.
Medication Options
- ACE inhibitors: examples include ramipril, which has been shown to reduce the risk of myocardial infarction, stroke, and cardiovascular death in patients with diabetes and cardiovascular disease 1.
- Angiotensin-receptor blockers (ARBs): examples include losartan, which has been shown to reduce the risk of kidney disease progression and cardiovascular events in patients with diabetes and hypertension 1.
- Thiazide diuretics: examples include chlorthalidone, which has been shown to be effective in preventing heart failure and reducing blood pressure in patients with hypertension 1.
- Calcium-channel blockers: examples include amlodipine, which has been shown to be effective in reducing blood pressure and cardiovascular events in patients with hypertension 1.
From the Research
First-Line Medication for Hypertension
The first-line medication for hypertension includes several options, as outlined in the following points:
- Thiazide or thiazide-like diuretics, such as hydrochlorothiazide or chlorthalidone, are recommended as first-line treatment for hypertension 2
- Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, such as enalapril or candesartan, are also considered first-line therapy 2
- Calcium channel blockers, such as amlodipine, are another option for first-line treatment 2, 3
- The choice of first-line medication may depend on the individual patient's characteristics and medical history 2
Comparison of First-Line Medications
Studies have compared the effectiveness of different first-line medications for hypertension, including:
- Thiazides, which have been shown to reduce mortality, stroke, coronary heart disease, and cardiovascular events 4
- Beta-blockers, which have been shown to reduce stroke and cardiovascular events, but not coronary heart disease or mortality 4
- ACE inhibitors, which have been shown to reduce mortality, stroke, coronary heart disease, and cardiovascular events 4
- Calcium channel blockers, which have been shown to reduce stroke and cardiovascular events, but not coronary heart disease or mortality 4
Single-Pill Combinations
Single-pill combinations of two antihypertensive drugs, such as a diuretic and an ACE inhibitor, may be used as first-line treatment for hypertension 5
- These combinations can help to simplify treatment regimens and improve adherence to medication 5