From the Guidelines
Hypertension management should prioritize a combination of lifestyle modifications and medication therapy to achieve target blood pressure levels below 130/80 mmHg for most adults, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.
Key Lifestyle Modifications
- Regular physical activity, such as brisk walking at least 30 minutes per day most days of the week, as suggested by the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure 1
- Adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan, which is rich in fruits, vegetables, and low-fat dairy products with a reduced content of dietary cholesterol as well as saturated and total fat 1
- Reducing sodium intake to no more than 100 mmol per day (2.4 g of sodium) 1
- Limiting alcohol intake to no more than 1 oz (30 mL) of ethanol per day in most men and no more than 0.5 oz of ethanol per day in women and lighter weight persons 1
- Maintaining a healthy weight and quitting smoking
Medication Therapy
- First-line agents include thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1
- Treatment typically begins with a single agent at a low dose, with gradual titration or addition of a second medication from a different class if blood pressure goals aren't met within 2-4 weeks
- Many patients require two or more medications for adequate control, and regular monitoring is essential to adjust treatment as needed
Resistant Hypertension
- Resistant hypertension is defined as blood pressure that remains above target despite the use of three or more antihypertensive medications, including a diuretic, as described in the prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 american college of cardiology/american heart association hypertension guideline 1
- Treatment of resistant hypertension includes maximization of diuretic therapy, addition of a mineralocorticoid receptor antagonist, and referral to a hypertension specialist if blood pressure remains uncontrolled.
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 Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake Many patients will require more than 1 drug to achieve blood pressure goals. 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
Hypertension Management involves:
- Lowering blood pressure to reduce the risk of cardiovascular events such as strokes and myocardial infarctions
- Comprehensive cardiovascular risk management including lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake
- Using multiple drugs to achieve blood pressure goals if necessary
- Considering the use of antihypertensive drugs from different pharmacologic classes to reduce cardiovascular morbidity and mortality 2
Similarly, for lisinopril:
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 Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake Many patients will require more than 1 drug to achieve blood pressure goals. 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
Key points for hypertension management with lisinopril are:
- Lowering blood pressure to reduce the risk of cardiovascular events
- Comprehensive cardiovascular risk management
- Using multiple drugs to achieve blood pressure goals if necessary
- Considering the use of antihypertensive drugs from different pharmacologic classes to reduce cardiovascular morbidity and mortality 3
From the Research
Lifestyle Modifications for Hypertension Management
- Lifestyle modifications are essential for preventing and controlling hypertension, as stated in the Canadian recommendations 4
- These modifications include maintaining a healthy body weight, moderating alcohol consumption, exercising regularly, reducing sodium intake, and altering intake of calcium, magnesium, and potassium 4
- The Dietary Approaches to Stop Hypertension (DASH) diet and modifications to the DASH diet, coupled with reductions in sodium intake, have been shown to lower blood pressure in pre-hypertensive and hypertensive individuals 5
- Regular physical exercise, body weight management, and healthy dietary patterns have been found to have preventive and antihypertensive effects 6
Pharmacological Interventions for Hypertension Management
- Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are widely prescribed for primary hypertension 7
- ACE inhibitors have been shown to reduce mortality and morbidity in placebo-controlled trials, while ARBs have not 7
- A comparison of the efficacies of ACE inhibitors and ARBs in primary hypertension found no evidence of a difference in total mortality or cardiovascular outcomes, but ARBs caused slightly fewer withdrawals due to adverse effects than ACE inhibitors 7
Role of Diet in Hypertension Management
- A diet high in sodium, energy-dense foods, fat content, refined carbohydrates, and added sugar contributes to an increased risk of developing hypertension and cardiovascular disease 5
- Adopting a diet rich in plant-based foods, whole grains, low-fat dairy products, and sodium intake within normal limits can be effective in preventing and managing hypertension 5
- Digital lifestyle interventions based on the DASH diet have been found to be effective in lowering blood pressure in pre-hypertensive and hypertensive individuals 5