From the Guidelines
The most effective blood pressure medication for lowering BP is typically chlorthalidone, a thiazide-type diuretic, as it has been shown to reduce systolic blood pressure by 20-30 mmHg in many patients 1.
Key Points to Consider
- Chlorthalidone works by helping the kidneys eliminate excess sodium and water from the body, reducing blood volume and therefore blood pressure.
- It is particularly effective because it has a long duration of action (up to 72 hours) compared to other diuretics like hydrochlorothiazide.
- For optimal results, it should be taken in the morning to prevent nighttime urination disrupting sleep.
- Side effects may include electrolyte imbalances (particularly potassium depletion), increased blood sugar, and elevated uric acid levels, so regular monitoring is important.
Individual Factors to Consider
- Age, race, comorbidities, and whether you have conditions like diabetes or kidney disease may make other medications (such as ACE inhibitors or calcium channel blockers) more appropriate for your specific situation.
- The European Society of Cardiology/European Society of Hypertension guidelines recommend treating with drugs from the following classes: ACE inhibitors, ARB, CCB, or diuretics, with initial combination therapy recommended in most patients with hypertension 1.
Important Considerations
- The combination of 2 renin-angiotensin system blockers is not recommended.
- β-blockers are considered to be first-line antihypertensive drugs in patients with a specific indication for their use, such as cardiac indications or pregnant women or women planning pregnancy 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Blood Pressure Medications
- Lisinopril is an effective medication for lowering blood pressure in patients with essential hypertension, with dosages of 20 to 80 mg once daily being effective in reducing blood pressure 2, 3.
- Lisinopril has been shown to be at least as effective as other medications such as hydrochlorothiazide, atenolol, metoprolol, and nifedipine in lowering blood pressure 2, 3.
- Combination therapy with an angiotensin-converting enzyme inhibitor (ACEI) and a calcium channel blocker (CCB) has been shown to be effective in reducing blood pressure and improving cardiovascular outcomes 4, 5.
- The ACEI/CCB combination has been shown to be well tolerated and may improve endothelial function more than either agent alone, potentially leading to better cardiovascular outcomes 4.
- Valsartan, an angiotensin II antagonist, has been shown to have similar antihypertensive efficacy to lisinopril, with a reduced incidence of cough 6.
Comparison of Medications
- Lisinopril and valsartan have been shown to have similar efficacy in reducing blood pressure, with lisinopril being associated with a higher frequency of drug-related cough 6.
- The choice of ACE inhibitor combination in hypertensive patients with type 2 diabetes should be based on individual patient needs and comorbidities, with consideration of the potential benefits and risks of each combination 5.