What are the preferred drugs for the treatment of hypertension among adult Filipinos for the prevention of cardiovascular diseases, specifically considering Angiotensin-Converting Enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARBs)?

From the Guidelines

The preferred drugs for the treatment of hypertension among adult Filipinos for prevention of cardiovascular diseases are ACE inhibitors and ARBs. These medications are recommended as first-line agents because they effectively lower blood pressure while providing additional cardiovascular protection, as supported by the most recent guidelines 1. ACE inhibitors like lisinopril, enalapril, and ramipril, and ARBs such as losartan, valsartan, and telmisartan work by modulating the renin-angiotensin-aldosterone system, which helps reduce blood pressure and provides organ protection, particularly for the heart and kidneys.

Key considerations for the use of these medications include:

• Typical starting doses: lisinopril 10mg daily, enalapril 5mg twice daily, losartan 50mg daily, or valsartan 80mg daily, with dose adjustments based on blood pressure response 1.
• Monitoring for side effects: dry cough with ACE inhibitors (which may necessitate switching to an ARB), hyperkalemia, or acute kidney injury, especially in those with pre-existing renal impairment 1.
• Lifestyle modifications: sodium restriction, regular exercise, and weight management should accompany pharmacological treatment for optimal blood pressure control 1.
• The combination of 2 renin-angiotensin system blockers is not recommended, and simultaneous use of ACE inhibitors and ARB should be avoided 1.

It's also important to note that these medications are especially beneficial for Filipino patients with diabetes, chronic kidney disease, or heart failure, as they provide additional organ protection beyond blood pressure reduction 1. Overall, the use of ACE inhibitors and ARBs as first-line agents for hypertension treatment in adult Filipinos is supported by the most recent and highest quality evidence, prioritizing morbidity, mortality, and quality of life outcomes.

From the FDA Drug Label

Losartan is indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older, to lower blood pressure. Lowering blood pressure lowers the risk of fatal and nonfatal cardiovascular (CV) events, primarily strokes and myocardial infarction 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 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 Lisinopril inhibits angiotensin-converting enzyme (ACE) in human subjects and animals.

The preferred drugs for the treatment of hypertension among adult Filipinos for the prevention of cardiovascular diseases, specifically considering Angiotensin-Converting Enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARBs), are:

• ACE inhibitors: Lisinopril
• ARBs: Losartan These drugs are indicated for the treatment of hypertension to lower blood pressure and reduce the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions 2, 3, 3. Key benefits of these drugs include:
• Reduction of cardiovascular morbidity and mortality
• Lowering of blood pressure to reduce the risk of fatal and nonfatal cardiovascular events
• Ability to be administered alone or with other antihypertensive agents It is essential to consider the individual patient's profile, including their renal function, race, and presence of other conditions such as diabetes or hyperlipidemia, when selecting therapy 2, 3, 3.

From the Research

Preferred Drugs for Hypertension Treatment

The preferred drugs for the treatment of hypertension among adult Filipinos, specifically considering Angiotensin-Converting Enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARBs), are discussed in the following points:

• ACE inhibitors and ARBs are recommended as first-line treatments for hypertension in various guidelines, including the American Heart Association scientific statement 4.
• A study comparing ACE inhibitors and ARBs found no difference in efficacy between the two in terms of blood pressure and outcomes, but ARBs had fewer adverse events 5.
• The 2020 Philippine Clinical Practice Guidelines for the management of hypertension recommend the use of ACE inhibitors and ARBs as part of the treatment regimen, but do not specify a preference between the two 6.
• Another study suggests that ARBs may be a better option than ACE inhibitors due to their equal outcome efficacy and fewer adverse events 5.

Treatment Considerations

When considering treatment options for hypertension among adult Filipinos, the following points should be taken into account:

• The prevalence of hypertension in the Philippines is high, with approximately 25.15% of the population affected, and only 27% of those with hypertension have their condition under control 7.
• The most common complications of hypertension in the Philippines are stroke, ischemic heart disease, chronic kidney disease, and hypertensive retinopathy 7.
• The treatment of hypertension should aim to reduce blood pressure to less than 140/90 mmHg, with lower targets for certain populations, such as those with diabetes or chronic kidney disease 4.
• A combination of lifestyle modifications and pharmacological treatments, including ACE inhibitors and ARBs, may be necessary to achieve optimal blood pressure control 4.