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Low-dose thiazide diuretics (eg, hydrochlorothiazide 12.5 to 25 mg/d) are the best first-line pharmacotherapy for treating uncomplicated hypertension (strength of recommendation [SOR]: A, based on randomized trials [RCTs] and 1 meta-analysis).
When are antihypertensive medications indicated in the treatment of hypertension (high blood pressure)?
In patients with stage 1 HTN, recommendations are to start antihypertensive medications if the patient has a 10-year ASCVD risk of 10% or higher with a target of BP less than 130/80 to prevent patients from cardiovascular events.
Which drug class is the best first choice for hypertension?
Thiazides best first choice for hypertension Review Question(s) In this first update of a review published in 2009, we wanted to determine which drug class was the best first‐line choice in treating adult patients with raised blood pressure.
When are different antihypertensive drug classes used as the first‐line drug?
Secondary objectives: when different antihypertensive drug classes are used as the first‐line drug, to quantify the blood pressure lowering effect and the rate of withdrawal due to adverse drug effects, compared to placebo or no treatment. Search methods
What are the different types of antihypertensive therapy?
Treatment was to be clearly defined as a specific class of first‐line antihypertensive therapy in one of the following classes: thiazide diuretics, beta blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, or alpha adrenergic blockers.
What medication is usually the first choice of hypertensive treatment?
The strongest body of evidence indicates that for most patients with hypertension, thiazide diuretics are the best proven first-line treatment in reducing morbidity and mortality.
What is the best drug for newly diagnosed hypertension?
Low-dose thiazide diuretics (eg, hydrochlorothiazide 12.5 to 25 mg/d) are the best first-line pharmacotherapy for treating uncomplicated hypertension (strength of recommendation [SOR]: A, based on randomized trials [RCTs] and 1 meta-analysis).
What is the initial treatment for stage 1 hypertension?
Initial first-line therapy for stage 1 hypertension includes thiazide diuretics, CCBs, and ACE inhibitors or ARBs. Two first-line drugs of different classes are recommended with stage 2 hypertension and average BP of 20/10 mm Hg above the BP target.
Why are ACE inhibitors first line for hypertension?
Introduction. ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers (ARBs) effectively lower blood pressure (BP) through inhibition of the renin-angiotensin system and are equally recommended as first-line medications in the treatment of hypertension.
Other Medications Sometimes Used to Treat High Blood Pressure
If you're unable to reach your blood pressure goal with one or more of the above medications, other drugs that lower blood pressure include: 1. Alp...
High Blood Pressure and Other Health Problems
High blood pressure often goes hand in hand with other health problems, including: 1. Heart failure 2. Previous heart attack or stroke 3. Coronary...
Keep Trying to Reach Your Blood Pressure Goal
It's not unusual to try several medications or doses before finding what works best for you. An important way for you and your doctor to know if yo...
What is the target BP for kidney disease?
In patients with chronic kidney disease, the target BP is 130/80. For patients with type 2 diabetes mellitus (T2DM), it is recommended to start on antihypertensive medications if BP is more than 130/80 with a goal of BP lower than 130/80.
What is the HTN stage?
The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of HTN stages is: Normal blood pressure (BP): systolic BP is less than 120, and diastolic BP is less than 80. Elevated BP: systolic BP 120 to 130 ...
Which is better, chlorthalidone or doxazosin mesylate?
Chlorthalidone, when compared with doxazosin mesylate, was better in preventing cardiovascular disease, when compared with lisinopril was found to be better in preventing cardiovascular disease, including strokes and heart failure incidence, and when compared with amlodipine was better in preventing heart failure.
How do beta blockers work?
Beta-blockers work by inhibiting the catecholamines from binding to the Beta 1,2, and 3 receptors. Beta-1 receptors are found primarily in the heart muscle, beta-2 receptors are located in the bronchial and peripheral vascular smooth muscles, and beta-3 receptors appear in adipose tissue of the heart.
Does hydrochlorothiazide lower blood pressure?
Switching to chlorthalidone from hydrochlorothiazide decreases systolic blood pressure by 7 to 8 mm Hg.
Is chlorthalidone better than hydrochlorothiazide?
They are better at decreasing the risk of cardiovascular disease comparing to hydrochlorothiazide. [4][5] Chlorthalidone is the drug of choice to start as monotherapy for hypertension. Studies show it to be the best diuretic to control blood pressure and to prevent mortality and morbidity.
Is spironolactone a good antihypertensive?
Spironolactone is superior to doxazosin and bisoprolol in lowering blood pressure when added to first-line antihypertensive agents in treating resistant hypertension. [28] Hydralazine can be added for the treatment of resistant hypertension, either alone or in combination with nitrates, in case of heart failure.
What is the risk of stage 2 hypertension?
For those with stage 2 hypertension or with preexisting cardiovascular disease, diabetes mellitus, chronic kidney disease, or a 10-year risk of cardiovascular disease of 10% or higher , both lifestyle change and medication are recommended.
Does salt intake affect blood pressure?
For example, patients with a high salt intake (e.g., eating primarily processed foods) may have a greater blood-pressure reduction with diuretic therapy, whereas those restricting salt intake may have a greater response to blockade of the renin–angiotensin system.
Can blood pressure medications reduce blood pressure?
A: Multiple clinical trials have shown that blood pressure can be effectively reduced by medications and that doing so results in a reduced incidence of target-organ events. The initial agent can be selected from one of four drug classes: angiotensin-converting–enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), calcium-channel blockers, and thiazide-type diuretics; each class has been shown to reduce cardiovascular events. The patient’s lifestyle, coexisting conditions, and clinical characteristics should be considered in selecting an agent. For example, patients with a high salt intake (e.g., eating primarily processed foods) may have a greater blood-pressure reduction with diuretic therapy, whereas those restricting salt intake may have a greater response to blockade of the renin–angiotensin system.
What are some examples of blood pressure medications?
Examples are spironolactone (Aldactone, Carospir) and eplerenone (Inspra). How well a drug works for you can depend on your age, sex, race, blood pressure level and overall health.
What are some examples of medications that can cause high blood pressure?
Examples include hydralazine and minoxidil. Aldosterone antagonists. These medications are often used with other drugs, such as a diuretic. Aldosterone antagonists block the hormone aldosterone, which sometimes causes salt and fluid retention, contributing to high blood pressure.
What are some examples of ACE inhibitors?
There are several ACE inhibitors available. Examples include enalapril (Vasotec, Epaned), lisinopril (Prinivil, Zestril, Qbrelis) and ramipril (Altace). Angiotensin II receptor blockers (ARBs). These drugs block the action of angiotensin, a chemical in your body that narrows your arteries and veins.
What are some examples of beta blockers?
Examples of beta blockers include metoprolol (Lopressor, Toprol-XL), nadolol (Corgard) and atenolol (Tenormin). Renin inhibitors. Renin is a substance produced by your kidneys that triggers a series of steps that increases blood pressure.
What are some examples of calcium channel blockers?
Examples of calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others), nifedipine (Adalat CC, Procardia) and verapamil (Verelan, Calan). Beta blockers. These drugs work by blocking the effects of the hormone epinephrine, also known as adrenaline.
What are the different types of diuretics?
There are three types of diuretics: thiazide, loop and potassium-sparing. Examples of diuretics include chlorothiazide (Diuril), bumetanide (Bumex) and amiloride (Midamor). If diuretics aren't enough to lower your blood pressure, your doctor might recommend adding other blood pressure medications to your treatment.
How well do drugs work?
How well a drug works for you can depend on your age, sex, race, blood pressure level and overall health. Combining two drugs usually works better than a single drug to get your blood pressure under control. Sometimes additional medication is needed to achieve your blood pressure goal.
What is the best medication for hypertension?
It’s been shown to be a great additive medication for resistant hypertension.”. Centrally acting agents, such as clonidine (Catapres, Kapvay), guanfacine (Intuniv) or methyldopa. These medications help slow your heart rate and keep your blood vessels from constricting by interfering with signals from the brain.
What is the best treatment for blood vessels?
Angiotensin-receptor blockers, such as losartan (Cozaar) or valsartan (Diovan). ARBs help block angiotensin and relax the blood vessels.
What is the role of a vasodilator in the kidney?
Vasodilators relax the muscles in the blood vessel walls, enabling blood to flow more easily. Loop diuretics, such as bumetanide (Bumex) or ethacrynic acid (Edecrin). These diuretics act on a different part of the kidney than thiazide diuretics. “Loop diuretics are secondary players,” Ajithan says.
What is the best medicine for kidneys?
Thiazide diuretics (“water pills”), such as hydrochlorothiazide (Microzide) and chlorothiazide (Diuril). Thiazide diuretics help relieve pressure on your blood vessels by prompting the kidneys to remove excess fluid and salt from your body. Calcium channel blockers, such as amlodipine (Norvasc) or diltiazem (Cardizem). ...
How do beta blockers help your heart rate?
Beta blockers help slow your heart rate by reducing the amount of stress hormones (such as adrenaline) in the body. The drugs might be used in people with an abnormal heartbeat or a history of heart attack. “Beta blockers are good at helping the heart remodel.
What to do if blood pressure isn't lowering?
If a medication isn’t doing enough to reduce your blood pressure after one month, your doctor may increase the dose or add another drug to your regimen. Medications in this arsenal include: Beta blockers, such as atenolol (Tenormin) or metoprolol (Lopressor).
What is the standard blood pressure for a high blood pressure patient?
First Lines of Defense. When you’re initially diagnosed with high blood pressure – typically defined as a measurement at or above 130/80 millimeters of mercury (mmHg) – your doctor will consider if you have any underlying conditions.
What is an antihypertensive?
Antihypertensive Medication Chart. Antihypertensive drugs are medications used to treat high blood pressure, also known as hypertension. There are several different classes, or categories, of antihypertensives based on their mechanism of action for lowering blood pressure.
What is the next class of antihypertensives?
The next class of antihypertensives is alpha blockers. The mechanism of action is self explanatory by their name as they block alpha receptors. In other words, alpha blockers are alpha receptor antagonists. Alpha blockers lower blood pressure primarily by blocking the alpha-1 receptors on blood vessels.
Why are dihydropyridines used more?
Dihydropyridines are used more for hypertension as they predominately target blood vessels, while nondihydropyridines (verapamil and diltiazem) are used more for tachydysrhythmias as they predominately target the heart. Since dihydropyridines are used more for hypertension , we will focus on those in this post.
What does A stand for in a drug?
A = Alpha Blockers. “A” will stand for several different antihypertensive medications with the first one being angiotensin-converting enzyme inhibitors, also known as ACE inhibitors . The second “A” stands for angiotensin II receptor blockers, also known as ARBs. The final “A” stands for alpha blockers.
How do alpha blockers lower blood pressure?
Alpha blockers lower blood pressure primarily by blocking the alpha-1 receptors on blood vessels. You might remember alpha receptors are a type of adrenergic receptor that play a role in our sympathetic nervous system, which is our flight or fight response when we are in stressful or dangerous situations.
What does the suffix "osin" mean in alpha blockers?
Alpha Blockers = “osin” (Selective Alpha-1) Alpha blockers end in “osin”, and many of the alpha blockers specific to treating hypertension end in “zosin”. It is important to note that the suffix “osin” or “zosin” mainly applies to selective alpha-1 blockers.
What is a non-selective alpha blocker?
There are also non-selective alpha-1 and alpha-2 blockers, and they typically end in “mine”. Nonselective alpha blockers include phentolamine and phenoxybenzamine, which are considered in the treatment of pheochromocytoma and cocaine-induced hypertension.
What is initial dual therapy?
However, in contrast with the 2013 guidelines, 2 in the 2018 guidelines, 1 initial dual therapy is the object of a strong recommendation rather than an advice and applies to a wider spectrum of hypertensive patients , thus becoming the standard approach.
Is dual therapy effective for hypertension?
In conclusion, the use of dual therapy as first-line antihypertensive treatment in most hypertensive patients, preferably in the form of SPCs, appears as a pragmatic and effective means to improve BP control and thus decrease the associated cardiovascular burden worldwide.