From the Guidelines
The most effective approach to managing hypertension is to use ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics as first-line treatments, as recommended by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. When managing hypertension, it is essential to consider the most recent guidelines, which emphasize the importance of using evidence-based treatments to reduce blood pressure and cardiovascular disease events.
Key Recommendations
- The use of ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics is recommended as first-line treatments for hypertension, as they have demonstrated the most effective reduction of blood pressure and cardiovascular disease events 1.
- Combination therapy with a RAS blocker and a dihydropyridine CCB or diuretic is recommended for most patients with confirmed hypertension, as it provides more effective blood pressure control compared to monotherapy 1.
- Fixed-dose single-pill combination treatment is recommended for patients receiving combination blood pressure-lowering treatment, as it improves adherence and reduces errors 1.
Treatment Approach
The treatment approach should be individualized based on the patient's specific needs and circumstances.
- For patients with confirmed hypertension, a combination of two drugs is recommended as initial therapy, with a RAS blocker and a dihydropyridine CCB or diuretic being the preferred combination 1.
- If blood pressure is not controlled with a two-drug combination, increasing to a three-drug combination is recommended, usually a RAS blocker with a dihydropyridine CCB and a thiazide/thiazide-like diuretic, and preferably in a single-pill combination 1.
- If blood pressure is not controlled with a three-drug combination, adding spironolactone or other medications should be considered, based on the patient's specific needs and circumstances 1.
From the Research
Guidelines for Hypertension Treatment
- The treatment of hypertension involves lifestyle modification and pharmacologic therapy 2.
- First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 2, 3.
- The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk 2.
- First-line drug therapy for hypertension consists of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 2, 4, 5.
Lifestyle Interventions
- Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, have been shown to have preventive and antihypertensive effects 3.
- Other lifestyle interventions, such as stress management and promotion of adequate sleep patterns, may also be beneficial in preventing and treating hypertension 3.
Pharmacologic Therapy
- Angiotensin-converting enzyme inhibitors and calcium channel blockers have been shown to be effective in preventing composite cardiovascular events in patients with hypertension 4.
- The combination of an angiotensin-converting enzyme inhibitor and a calcium channel blocker may be more effective than the combination of a thiazide diuretic and an angiotensin-converting enzyme inhibitor in preventing cardiovascular events 4.
- Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have been shown to be equally effective in the management of hypertension, but angiotensin receptor blockers may have improved tolerability 5.
Clinical Practice Guidelines
- Clinical practice guidelines for hypertension treatment may not always consider the impact of multiple chronic conditions, socio-personal context, and patient preferences 6.
- Guideline panels should consider these factors when developing guidelines to ensure that they are practical and effective in guiding patient care 6.