What is the most suitable antihypertensive medication for a 38-year-old female with newly diagnosed Hypertension (HTN) and elevated Intraocular Pressure (IOP)?

From the Guidelines

For a 38-year-old female with newly diagnosed hypertension and elevated intraocular pressure, an ACE inhibitor or ARB, such as lisinopril or losartan, would be the best initial medication choice. These medications are preferred due to their ability to inhibit the renin-angiotensin-aldosterone system, which is beneficial in patients with hypertension and potential fluid retention issues, as mentioned in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.

• The use of ACE inhibitors or ARBs is supported by the guideline, which states that renin-angiotensin-aldosterone system inhibition would represent the preferred choice for antihypertensive therapy in patients with hypertension and potential fluid retention issues.
• A typical starting dose would be lisinopril 10-20mg once daily or losartan 50mg once daily, with the goal of reducing blood pressure to less than 130/80 mmHg.
• It's essential to monitor blood pressure regularly after starting therapy, typically checking weekly, and scheduling follow-up appointments to assess the effectiveness of the medication and potential side effects.
• Additionally, the patient's intraocular pressure should be monitored regularly, and if necessary, topical medications such as beta-blockers (e.g., timolol) can be added to control intraocular pressure, as they have been shown to be effective in reducing both blood pressure and intraocular pressure 1.

From the FDA Drug Label

The antihypertensive effect of losartan was studied in one trial enrolling 177 hypertensive pediatric patients aged 6 to 16 years old. Analysis of age, gender, and race subgroups of patients showed that men and women, and patients over and under 65, had generally similar responses. Losartan was effective in reducing blood pressure regardless of race, although the effect was somewhat less in Black patients (usually a low-renin population)

The best blood pressure medication to start on a 38 y/o female with new diagnosis of HTN is losartan, as it has been shown to be effective in reducing blood pressure in patients of similar age and gender. However, the effect of losartan on elevated intraocular pressure is not directly addressed in the provided drug label.

• Key considerations:
  • Losartan has been shown to be effective in reducing blood pressure in patients with hypertension.
  • The effect of losartan on elevated intraocular pressure is not directly addressed in the provided drug label.
  • It is essential to consult with a healthcare professional to determine the best course of treatment for this patient. 2

From the Research

Hypertension Treatment Options

The treatment of hypertension (HTN) in a 38-year-old female with a new diagnosis and elevated intraocular pressure requires careful consideration of the available medication options.

• Angiotensin Receptor Blockers (ARBs) are recommended as a first-line treatment for hypertension due to their effectiveness in lowering blood pressure and protecting against cardiovascular and renal damage 3.
• ARBs have been shown to have a comparable effect to Angiotensin-Converting Enzyme Inhibitors (ACEi) in lowering blood pressure, but with better pharmacological tolerability 3.
• The combination of an ARB with a calcium channel blocker (CCB) or a diuretic, such as hydrochlorothiazide (HCTZ), can improve left ventricular relaxation in patients with hypertension and diastolic dysfunction 4.

Considerations for Elevated Intraocular Pressure

When considering the treatment of hypertension in a patient with elevated intraocular pressure, it is essential to choose an agent that will not exacerbate the condition.

• Calcium channel blockers, such as amlodipine, have been shown to be effective in lowering blood pressure and improving left ventricular relaxation, and may be a suitable option for patients with elevated intraocular pressure 4.
• There is limited evidence to suggest that any particular antihypertensive medication is contraindicated in patients with elevated intraocular pressure, but careful monitoring of intraocular pressure is recommended when initiating treatment 5.

Treatment Recommendations

Based on the available evidence, an ARB or a CCB may be a suitable first-line treatment option for a 38-year-old female with a new diagnosis of hypertension and elevated intraocular pressure.

• Losartan, an ARB, has been shown to be effective in lowering blood pressure and improving left ventricular relaxation when combined with HCTZ 4.
• Amlodipine, a CCB, has also been shown to be effective in lowering blood pressure and improving left ventricular relaxation when combined with an ARB 4.