From the Guidelines
Blood pressure medications for hypertension (HTN) should not be taken "as needed" but rather as part of a regular, scheduled regimen to maintain consistent blood pressure control. Hypertension is a chronic condition that requires ongoing management to prevent complications such as cardiovascular disease, kidney damage, and stroke. The most recent and highest quality study, 1, recommends the use of specific drug classes as first-line agents for the treatment of hypertension, including thiazide and thiazide-like agents, angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, and long-acting dihydropyridine calcium channel blockers.
Key Considerations
- The fundamental issue with "as needed" dosing is that it can lead to dangerous blood pressure fluctuations and inadequate overall control, as medications work best when maintaining steady blood levels in the system 1.
- If a patient is experiencing occasional blood pressure spikes, it is essential to speak with a healthcare provider about adjusting the regular medication regimen rather than relying on as-needed dosing.
- Some medications, such as clonidine or captopril, may be used situationally under specific physician guidance, but this is not standard practice and may cause side effects like dizziness or rapid blood pressure drops 1.
- The World Health Organization recommends the use of specific drug classes as initial treatment for adults with hypertension requiring pharmacologic treatment, with a strong recommendation and high-quality evidence 1.
Recommendations for Management
- Regular, scheduled antihypertensive medication is the most appropriate approach for managing hypertension.
- Patients should work with their healthcare provider to adjust their medication regimen as needed to maintain consistent blood pressure control.
- The use of "as needed" medications should be avoided, and instead, patients should focus on maintaining a consistent medication schedule to prevent complications and ensure optimal management of their condition.
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. Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure.
Lisinopril and Amlodipine can be used as needed for blood pressure management in hypertension.
- Lisinopril may be administered alone or with other antihypertensive agents.
- Amlodipine may be used alone or in combination with other antihypertensive agents. 2 3
From the Research
Treatment Options for Hypertension
- Calcium channel blockers, such as nifedipine and amlodipine, are effective in treating mild-to-moderate essential hypertension 4.
- Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril, are also used to treat hypertension, but may be associated with adverse events like cough and angioedema 5.
- The combination of amlodipine and lisinopril has been shown to have a marked additional effect on blood pressure compared to either drug alone 6.
Efficacy and Safety of Treatment Options
- Nifedipine and amlodipine have been found to be comparably safe and effective in treating patients with mild-to-moderate essential hypertension 4.
- ACE inhibitors, such as lisinopril, have been found to be effective in lowering blood pressure, but may be associated with a higher risk of adverse events compared to angiotensin receptor blockers (ARBs) 5.
- The combination of amlodipine and lisinopril has been found to be well-tolerated and effective in lowering blood pressure 6.
Predictors of Response to Treatment
- The response to lisinopril has been found to be related to baseline plasma renin activity 6.
- The response to amlodipine has been found to be independent of baseline renin activity, but may be associated with the severity of hypertension 6.
- Black patients may not respond as well to lisinopril as Caucasian patients, but may respond similarly to the combination of amlodipine and lisinopril 6.