What is the first-line treatment?

From the Guidelines

First-line treatment for hypertension should include drugs from one of the following classes: thiazide and thiazide-like agents, angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, or long-acting dihydropyridine calcium channel blockers, as recommended by the World Health Organization 1. When considering first-line treatment options, it's essential to prioritize medications with a strong evidence base for efficacy and safety. The WHO guideline 1 provides a comprehensive overview of the recommended pharmacologic treatments for adults with hypertension. Key points to consider when selecting a first-line treatment include:

• The use of thiazide and thiazide-like agents, such as hydrochlorothiazide, as a viable option 1
• The role of angiotensin converting-enzyme inhibitors, like lisinopril, in managing hypertension 1
• The effectiveness of angiotensin receptor blockers, such as losartan, in reducing blood pressure 1
• The use of long-acting dihydropyridine calcium channel blockers, like amlodipine, as a first-line treatment option 1 These medication classes are recommended due to their high quality evidence and strong recommendation by the WHO 1.

From the FDA Drug Label

In a large (1,395 patients randomized), double-blind, placebo-controlled clinical study, metoprolol was shown to reduce 3-month mortality by 36% in patients with suspected or definite myocardial infarction DOSAGE & ADMINISTRATION Myocardial Infarction Early Treatment During the early phase of definite or suspected acute myocardial infarction, initiate treatment with metoprolol tartrate as soon as possible after the patient’s arrival in the hospital. The first line treatment for myocardial infarction is metoprolol, which should be initiated as soon as possible after the patient's arrival in the hospital, with a dosage regimen that includes intravenous administration followed by oral maintenance therapy 2 2.

• The initial treatment consists of three bolus injections of 5 mg of metoprolol tartrate injection each, given at approximately 2-minute intervals.
• After the intravenous dose, metoprolol tartrate tablets should be initiated at a dose of 50 mg every 6 hours for 48 hours, and then maintained at a dose of 100 mg orally twice daily.

From the Research

First-Line Treatment for Hypertension

• The first-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 3.
• When drug therapy is required, first-line therapies are thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and calcium channel blockers 3.
• Calcium channel blockers (CCBs) are often recommended as a first-line drug to treat hypertension, but their effect on the prevention of cardiovascular events compared to other antihypertensive drug classes is still debated 4, 5.
• CCBs have been shown to reduce major cardiovascular events and stroke when compared to beta-blockers, but increase congestive heart failure events when compared to diuretics, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers 4, 5.

Comparison of Antihypertensive Drug Classes

• Diuretics are preferred over CCBs to optimize reduction of cardiovascular events 4, 5.
• Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have similar efficacy to CCBs in reducing blood pressure and cardiovascular events, but with fewer adverse events 6.
• Beta-blockers in combination with angiotensin-converting enzyme inhibitors are of special interest due to their complementary actions on the sympathetic nervous system and renin-angiotensin-aldosterone system 7.

Treatment Goals and Outcomes

• The goal of hypertension treatment is to achieve a blood pressure target of <130/80 mm Hg for adults <65 years and <130 mm Hg for adults ≥65 years 3.
• Randomized clinical trials have established the efficacy of blood pressure lowering to reduce the risk of cardiovascular disease morbidity and mortality 3.
• An SBP reduction of 10 mm Hg decreases the risk of cardiovascular disease events by approximately 20% to 30% 3.