From the Guidelines
The first line treatment for hypertension should include ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics, with a preferred combination of a RAS blocker with a dihydropyridine CCB or diuretic, as recommended by the 2024 ESC guidelines 1.
Key Considerations
- Lifestyle modifications, such as reducing sodium intake, adopting the DASH diet, regular physical activity, limiting alcohol consumption, maintaining healthy weight, and smoking cessation, should be implemented before initiating medication.
- Medication should be considered if blood pressure remains above 140/90 mmHg despite lifestyle modifications.
- The choice of medication depends on patient characteristics, with ACE inhibitors or ARBs preferred for those with diabetes or chronic kidney disease.
- Combination therapy with two or more medications is generally required to achieve blood pressure targets, with a preferred combination of a RAS blocker with a dihydropyridine CCB or diuretic.
Medication Options
- ACE inhibitors (e.g. lisinopril 10-40mg daily) 1
- Angiotensin II receptor blockers (e.g. losartan 50-100mg daily) 1
- Dihydropyridine calcium channel blockers (e.g. amlodipine 5-10mg daily) 1
- Diuretics (e.g. hydrochlorothiazide 12.5-25mg daily) 1
Monitoring and Adjustments
- Treatment should be monitored regularly, with dose adjustments as needed to reach target blood pressure.
- 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 AND ADMINISTRATION Therapy should be initiated with the lowest possible dose. Hypertension Initiation Therapy, in most patients, should be initiated with a single daily dose of 25 mg.
- 1 Hypertension Losartan is indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older, to lower blood pressure.
The first line treatment for hypertension is not explicitly stated in the provided drug labels. However, based on the information given, chlorthalidone can be initiated with a single daily dose of 25 mg and losartan is indicated for the treatment of hypertension, but the initial dose is not specified in the provided text.
- The dose of chlorthalidone may be increased to 50 mg or 100 mg if the response is insufficient.
- Losartan may be administered with other antihypertensive agents. 2 3
From the Research
First-Line Treatment for Hypertension
The first-line treatment for hypertension includes:
- Lifestyle modification, consisting of weight loss, dietary sodium reduction and potassium supplementation, healthy dietary pattern, physical activity, and limited alcohol consumption 4, 5, 6, 7
- First-line drug therapy for hypertension consists of:
Benefits of First-Line Treatment
The benefits of first-line treatment for hypertension include:
- Reduction in the risk of cardiovascular disease (CVD) events, such as coronary heart disease, heart failure, and stroke 4, 5, 6, 8
- Lowering of blood pressure, with a target of less than 130/80 mm Hg for adults under 65 years and less than 130 mm Hg for adults over 65 years 4
- Reduction in the risk of CVD morbidity and mortality, with an SBP reduction of 10 mm Hg decreasing the risk of CVD events by approximately 20% to 30% 4
Importance of Lifestyle Modification
Lifestyle modification is an essential component of first-line treatment for hypertension, with benefits including:
- Lowering of blood pressure through weight loss, dietary changes, and increased physical activity 6, 7
- Reduction in the risk of CVD events and mortality through improved vascular health and reduced sympathetic overactivation 6, 7
- Improved overall health and well-being through healthy lifestyle habits 6, 7