From the Guidelines
For patients with high diastolic blood pressure, the most effective treatment approach is to start with a single-pill combination of two major drug classes, such as an ACE inhibitor and a dihydropyridine calcium channel blocker (CCB), or an angiotensin receptor blocker (ARB) and a thiazide or thiazide-like diuretic, as recommended by the 2024 ESC guidelines 1. This approach can lead to greater blood pressure reduction and has the potential to target multiple pathophysiological pathways contributing to hypertension. When selecting a specific medication, consider the following options:
- ACE inhibitors (like lisinopril 10-40mg daily or ramipril 2.5-20mg daily)
- ARBs (such as losartan 25-100mg daily or valsartan 80-320mg daily)
- Dihydropyridine CCBs (such as amlodipine 5-10mg daily)
- Thiazide or thiazide-like diuretics (such as hydrochlorothiazide 12.5-25mg daily) It's essential to start with a low dose and gradually increase while monitoring blood pressure response, as well as considering individual factors including age, race, comorbidities, and potential side effects 1. Lifestyle modifications, including reduced sodium intake, regular exercise, weight management, limited alcohol consumption, and stress reduction, should accompany medication therapy. Regular blood pressure monitoring at home is crucial to track effectiveness, and follow-up with your healthcare provider is necessary to adjust treatment as needed. In cases where blood pressure remains uncontrolled, consider adding spironolactone or other mineralocorticoid receptor antagonists (MRAs) as a fourth-line treatment option, as they have been shown to be effective in reducing blood pressure in patients with resistant hypertension 1.
From the FDA Drug Label
In controlled clinical studies of patients with mild to moderate hypertension, patients were treated with lisinopril 20 mg to 80 mg daily, hydrochlorothiazide 12. 5 mg to 50 mg daily or atenolol 50 mg to 200 mg daily; and in other studies of patients with moderate to severe hypertension, patients were treated with lisinopril 20 mg to 80 mg daily or metoprolol 100 mg to 200 mg daily. Lisinopril demonstrated superior reductions of systolic and diastolic compared to hydrochlorothiazide in a population that was 75% Caucasian Lisinopril was approximately equivalent to atenolol and metoprolol in reducing diastolic blood pressure, and had somewhat greater effects on systolic blood pressure.
The best BP med for diastolic that is high is lisinopril, as it has been shown to be effective in reducing diastolic blood pressure, with doses ranging from 20 mg to 80 mg daily. However, it is essential to note that the effectiveness of lisinopril may vary depending on the population, with superior reductions observed in a predominantly Caucasian population. Additionally, lisinopril was found to be approximately equivalent to atenolol and metoprolol in reducing diastolic blood pressure 2.
From the Research
Treatment Options for High Diastolic Blood Pressure
- The European hypertension guidelines recommend combining angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs) with calcium channel blockers (CCBs) and/or thiazide diuretics to improve blood pressure control 3.
- Studies have shown that combining two different classes of antihypertensive drugs has an additive effect on lowering blood pressure, without increasing adverse events 3, 4.
- A fixed-dose combination of an ACE inhibitor and a calcium channel blocker has been found to be an optimal combination for the treatment of hypertension, particularly for patients with uncontrolled hypertension or cardiovascular risk factors 5.
- A fixed-dose ACE inhibitor-diuretic combination has been shown to reduce ambulatory blood pressures and arterial stiffness in isolated systolic hypertension more than antihypertensive monotherapy 6.
Specific Medications for High Diastolic Blood Pressure
- Olmesartan, an ARB, has been found to be effective in lowering blood pressure when used in combination with amlodipine, a calcium channel blocker, or hydrochlorothiazide, a thiazide diuretic 3.
- Amlodipine has been shown to be effective in lowering diastolic blood pressure, with a significant reduction in 5-year diastolic blood pressure compared to chlorthalidone 4.
- Diuretics, such as chlorthalidone, have been found to be superior in preventing major forms of cardiovascular disease and are less expensive than other antihypertensive medications 4.
- Calcium channel blockers, such as amlodipine, have been found to be effective in lowering systolic blood pressure in elderly patients with previously untreated hypertension 7.