From the Guidelines
The most effective approach to managing hypertension involves initiating treatment with a combination of two BP-lowering medications, typically including a thiazide diuretic, ACE inhibitor, ARB, or calcium channel blocker, as recommended by the 2024 ESC guidelines 1. When selecting the initial medication, it's crucial to consider comorbid conditions, such as heart failure or chronic kidney disease, for which specific classes of BP-lowering medications are indicated.
- Thiazide diuretics, like chlorthalidone, have been shown to be superior in preventing heart failure and stroke compared to ACE inhibitors and calcium channel blockers in certain populations 1.
- ACE inhibitors, such as lisinopril, may be less effective in lowering BP and preventing stroke, especially in black patients, compared to thiazide diuretics and calcium channel blockers 1.
- ARBs, like losartan, may be better tolerated than ACE inhibitors in black patients but offer no proven advantage in preventing stroke or cardiovascular disease in this population 1. Key considerations for BP management include:
- Starting with a low dose and adjusting based on response
- Using single-pill combinations to improve adherence and reduce side effects
- Monitoring BP regularly and aiming for a target below 130/80 mmHg
- Implementing lifestyle modifications, such as reducing sodium intake, exercising regularly, and maintaining a healthy weight, to complement medication therapy. The 2024 ESC guidelines recommend upfront combination therapy with a Class I recommendation, citing the benefits of improved BP control, reduced side effects, and increased adherence 1.
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. Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure.
BP Medication Options:
- Losartan: indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older.
- Amlodipine: indicated for the treatment of hypertension, to lower blood pressure. Both medications are used to lower blood pressure and reduce the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions 2 3.
From the Research
BP Medication Options
- There are several medication options available for the treatment of hypertension, including ACE inhibitors, calcium channel blockers, and diuretics 4, 5, 6, 7.
- ACE inhibitors, such as lisinopril, have been shown to be effective in lowering blood pressure in patients with essential hypertension 4.
- Calcium channel blockers, such as amlodipine, have also been found to be effective in reducing blood pressure and improving patient outcomes 5, 7.
Comparison of Medications
- A comparison of ACE inhibitors and angiotensin receptor blockers (ARBs) found no difference in efficacy between the two in terms of blood pressure reduction and outcomes 6.
- However, ACE inhibitors were found to be associated with a higher risk of adverse events, such as cough and angioedema, compared to ARBs 6.
- Amlodipine, a calcium channel blocker, has been found to have a low risk of adverse events and is considered a cost-effective option for the treatment of hypertension 7.
Specific Medication Profiles
- Lisinopril, an ACE inhibitor, has been shown to be effective in lowering blood pressure in patients with essential hypertension, with a dosage of 20-80 mg once daily 4.
- Amlodipine, a calcium channel blocker, has been found to have a unique profile, with a long half-life and duration of action, allowing for sustained blood pressure reduction with once-daily dosing 7.