From the Guidelines
Hypertension is a chronic medical condition characterized by elevated blood pressure, defined as a systolic pressure of 130 mmHg or higher and a diastolic pressure of 80 mmHg or higher 1.
Diagnosis and Treatment
The diagnosis of hypertension is based on accurate measurement of blood pressure, and treatment typically involves lifestyle modifications, including dietary changes and increased physical activity, followed by pharmacological intervention with medications such as lisinopril (10-40 mg daily) or amlodipine (5-10 mg daily) for a minimum of 6-12 months to achieve optimal blood pressure control 1.
Pharmacological Treatment
For patients with stage 2 hypertension, combination therapy with two or more medications, including a diuretic such as hydrochlorothiazide (12.5-25 mg daily), may be necessary to achieve a target blood pressure of less than 130/80 mmHg 1. The choice of antihypertensive agent should be based on the patient's individual characteristics, such as age, comorbidities, and concurrent medications 1.
Lifestyle Modifications
Lifestyle modifications, such as weight loss, reducing sodium intake, increasing potassium intake, moderation of alcohol consumption, and increased physical activity, can also help to lower blood pressure and reduce the risk of cardiovascular disease 1.
Target Blood Pressure
The target blood pressure for most patients is less than 130/80 mmHg, although this may vary depending on individual patient characteristics, such as age and comorbidities 1.
Combination Therapy
Combination therapy with two or more medications may be necessary to achieve optimal blood pressure control, and the choice of medications should be based on their complementary mechanisms of action 1.
Patient-Specific Factors
Patient-specific factors, such as age, concurrent medications, drug adherence, drug interactions, and comorbidities, should be taken into account when selecting antihypertensive therapy 1.
Global Guidance
The World Health Organization (WHO) has published guidelines for the pharmacological treatment of hypertension in adults, which provide evidence-based recommendations for the management of hypertension in routine, primary care settings 1.
From the FDA Drug Label
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. Amlodipine besylate is a type of medicine known as a calcium channel blocker (CCB). It is used to treat high blood pressure (hypertension) and a type of chest pain called angina.
The diagnosis of Hypertension (High Blood Pressure) is not explicitly stated in the provided drug labels, but it can be inferred that it is characterized by elevated systolic or diastolic pressure. The treatment for Hypertension (High Blood Pressure) includes:
- Lisinopril to lower blood pressure and reduce the risk of fatal and non-fatal cardiovascular events
- Amlodipine besylate to relax blood vessels and lower blood pressure
- Comprehensive cardiovascular risk management, including:
- Lipid control
- Diabetes management
- Antithrombotic therapy
- Smoking cessation
- Exercise
- Limited sodium intake It is recommended to follow published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC), for specific advice on goals and management of high blood pressure 2.
From the Research
Diagnosis of Hypertension
- Hypertension is defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg 3
- The diagnosis of hypertension involves accurate standardized blood pressure (BP) measurement, assessment of the patients' predicted risk of atherosclerotic CVD and evidence of target-organ damage, and detection of secondary causes of hypertension and presence of comorbidities (such as CVD and kidney disease) 4
- Ambulatory and home blood pressure monitoring can improve diagnostic accuracy 5
Treatment of Hypertension
- First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern that includes low sodium and high potassium intake, physical activity, and moderation or elimination of alcohol consumption 3, 6
- The BP-lowering effects of individual lifestyle components are partially additive and enhance the efficacy of pharmacologic therapy 3
- First-line drug therapy for hypertension consists of a thiazide or thiazidelike diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 3, 5, 4
- The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk 3
- Thresholds for pharmacologic intervention and blood pressure goals differ according to various guidelines 5
Lifestyle Management
- Lifestyle changes, including dietary modifications and increased physical activity, are effective in lowering BP and preventing hypertension and its CVD sequelae 4, 6
- Specific recommendations for lifestyle management include maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels 6
- Lifestyle changes should be continued even when blood pressure-lowering medications are prescribed 6
Blood Pressure Goals
- Evidence strongly supports reducing blood pressure to less than 140/90 mm Hg to reduce the risk of all-cause and cardiovascular mortality in adults with hypertension 5
- Lowering blood pressure to less than 135/85 mm Hg may further reduce the risk of myocardial infarction 5
- An SBP reduction of 10 mm Hg decreases risk of CVD events by approximately 20% to 30% 3