From the Guidelines
A typical regimen for controlling hypertension often begins with lifestyle modifications alongside medication therapy, with first-line medications including thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers, or calcium channel blockers. The choice of medication should be individualized based on age, race, comorbidities, and potential side effects. For example, ACE inhibitors are preferred in patients with diabetes or heart failure, while calcium channel blockers may work better in Black patients 1.
Key Considerations
- Treatment is typically initiated with a single agent at a low dose, then titrated upward if blood pressure remains above target (generally <130/80 mmHg) 1.
- If a single medication at maximum dose is insufficient, a second drug from a different class is added.
- Many patients require two or more medications for adequate control.
- Beta-blockers are often used as add-on therapy or in patients with specific comorbidities like coronary artery disease.
Medication Options
- Thiazide diuretics (hydrochlorothiazide 12.5-25mg daily)
- ACE inhibitors (lisinopril 10-40mg daily)
- Angiotensin II receptor blockers (losartan 25-100mg daily)
- Calcium channel blockers (amlodipine 5-10mg daily)
- Beta-blockers (metoprolol 25-100mg twice daily)
Monitoring and Follow-up
- Regular monitoring of blood pressure and kidney function is essential.
- Patients should be advised to take medications consistently at the same time each day for optimal effect.
- Serum creatinine/estimated glomerular filtration rate and serum potassium levels should be monitored at least annually in patients treated with an ACE inhibitor, angiotensin receptor blocker, or diuretic 1.
From the FDA Drug Label
DOSAGE & ADMINISTRATION 2. 1 Hypertension Initial Therapy in adults: The recommended initial dose is 10 mg once a day. Dosage should be adjusted according to blood pressure response. The usual dosage range is 20 mg to 40 mg per day administered in a single daily dose.
- Lisinopril: The typical regimen for controlling hypertension is an initial dose of 10 mg once a day, with a usual dosage range of 20 mg to 40 mg per day.
- Hydrochlorothiazide: The adult initial dose is one capsule given once daily, with total daily doses greater than 50 mg not recommended 2, 3.
From the Research
Typical Regimen for Controlling Hypertension
The typical regimen for controlling hypertension involves a combination of lifestyle modifications and pharmacological therapy.
- Lifestyle modifications include:
- Weight loss
- Healthy dietary pattern with low sodium and high potassium intake
- Physical activity
- Moderation or elimination of alcohol consumption
- Pharmacological therapy includes:
- Thiazide or thiazide-like diuretics such as hydrochlorothiazide or chlorthalidone
- Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers such as enalapril or candesartan
- Calcium channel blockers such as amlodipine
Drug Dosage
The dosage of these drugs may vary depending on the individual patient's needs and response to treatment.
- For example, the combination of amlodipine 5-10 mg + valsartan 160 mg or lisinopril 10-20 mg + hydrochlorothiazide 12.5 mg has been shown to be effective in reducing blood pressure in patients with stage 2 hypertension 4.
- The dosage of these drugs should be titrated according to office and home blood pressure levels to achieve a target blood pressure of <130/80 mm Hg for adults <65 years and <130 mm Hg for adults ≥65 years 5.
Blood Pressure Targets
The target blood pressure for patients with hypertension is:
- <130/80 mm Hg for adults <65 years
- <130 mm Hg for adults ≥65 years
- <140/90 mm Hg for patients with chronic kidney disease or diabetes mellitus 6
Combination Therapy
Combination therapy with multiple antihypertensive agents is often required to achieve adequate blood pressure control.