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Learn More...What are the first line medications for hypertension?
- Normal blood pressure (BP): systolic BP is less than 120, and diastolic BP is less than 80.
- Elevated BP: systolic BP 120 to 130 and diastolic BP is less than 80.
- Stage 1 HTN: systolic BP 130 to 139 or diastolic BP 80 to 89.
- Stage 2 HTN: systolic BP at least 140 or diastolic at least 90.
What is the first line drug for hypertension?
Thiazide and thiazide-like diuretics are usually the first-line of treatment for hypertension; in JNC8 guidelines, the thiazide diuretics can be used as the first-line treatment for HTN (either alone or in combination with other antihypertensives) in all age groups regardless of race unless the patient has evidence of chronic kidney disease where angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker is indicated.
What is first line therapy for hypertension?
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 essential HTN?
are two forms of pulmonary hypertension (PH) characterized by obstructive vasculopathy. Endothelial dysfunction along with metabolic changes towards increased glycolysis are important in PAH pathophysiology. Less is known about such abnormalities in ...
What is the goal of uncomplicated hypertension?
Summary. The goal of therapy in uncomplicated hypertension is to reduce cardiovascular risk by lowering the patient's blood pressure. If non-drug treatment is ineffective, the choice of drug treatment is determined by its safety and efficacy. When safety and efficacy are equal the lowest cost drug should be prescribed.
Why do people with essential hypertension stop taking calcium channel blockers?
Patients with essential hypertension taking calcium channel blockers stop their medication because of adverse effects more frequently than those patients taking diuretics. 2. Thiazide diuretics are no longer first-line treatment for uncomplicated hypertension.
Is hypertension a family history?
These patients commonly have a family history of hypertension, but clinical assessment and selective investigation reveal no primary underlying cause of the hypertension.
Is it safe to take antihypertensives?
Compared with drugs used for other chronic disorders, antihypertensives are among the safest. They cause very little specific organ toxicity and many of them have been in use for many years so their adverse effects are well known. Periodically there are alarms about particular classes - for example, the precipitation of vascular occlusion with short-acting calcium channel blocking drugs or cardiovascular collapse with hypotension when starting an ACE inhibitor. However, most of these problems can be avoided with appropriate prescribing and monitoring of treatment.
Does blood pressure reduce cardiovascular morbidity?
Recent results from very large studies and (many) meta-analyses show that it is the reduction in blood pressure itself that leads to lower cardiovascular morbidity and mortality. It is the reduction in blood pressure that counts and not the drug class used to reduce it.
Does salt and alcohol help with blood pressure?
Reducing excess weight, salt and alcohol intake coupled with increased exercise all reduce blood pressure. However, few studies have shown prolonged effectiveness of these interventions and study design has often been poor. 3 In a majority of patients medication will also be needed to reach their target blood pressure.
Is thiazide a first line diuretic?
However, for most patients with uncomplicated hypertension low-dose thiazide-type diuretics should be first-line therapy. The choice of add-on therapy, which may be required later in up to two-thirds of patients, is not as clearly defined. Beta blocking drugs and ACE inhibitors are effective when used with a diuretic.
What is the best diuretic for hypertension?
Thiazide diuretics — The preferred thiazide diuretic in patients with primary hypertension is chlorthalidone since major trials such as ALLHAT have shown benefit with this regimen. Indapamide, another thiazide-like diuretic, may be used in place of chlorthalidone.
Does beta blocker help with stroke?
Compared with other antihypertensive drugs in the primary treatment of hypertension, beta blockers ( not all trials used atenolol) may be associated with inferior protection against stroke risk and all-cause mortality [ 76-80 ]. These effects are primarily seen in patients over age 60 years [ 79,81-83 ].
Treatment
Overview
- Hypertension requiring treatment exists when a patient's blood pressure, measured on at least three separate occasions, exceeds the threshold pressures which predict an increased cardiovascular risk, in the absence of complicating features such as diabetes mellitus and overt cardiovascular disease. These patients commonly have a family history of hypertension, but clin…
Criticism
- Controlled clinical trials are often criticised for their lack of representativeness. This may undermine the doctor's confidence in applying the results to individual patients, however, we have no better evidence than these trials. The differences which occur between trials are often exploited in drug promotion, so how do we account for these discrepancies?
Results
- The differences may reflect the design of the trials. Results from non-randomised studies are more likely to be favourable to the drug of interest than those of randomised trials. Within randomised trials, less weight should be given to the results if allocation to treatment or control arms was not concealed. The populations included in the trials may not be comparable (for exa…
Medical uses
- The criteria by which we select one class of drug as first-line treatment are usually dominated by comparative efficacy. In hypertension all the five major drug classes (low-dose thiazides, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists) are efficacious in reducing blood ...
Availability
- While the conclusion of the National Heart Foundation guidelines (2004)5 that 'Drugs from any of the five major classes are suitable for initiation and maintenance of antihypertensive therapy' is correct, this is true only if efficacy is considered alone. Other considerations also have a place in the choice of first-line drugs. The World Health Organization program, the 'Guide to good prescri…
Safety
- Compared with drugs used for other chronic disorders, antihypertensives are among the safest. They cause very little specific organ toxicity and many of them have been in use for many years so their adverse effects are well known. Periodically there are alarms about particular classes - for example, the precipitation of vascular occlusion with short-acting calcium channel blocking drug…
Adverse effects
- Patients with hypertension are often overweight and have an increased likelihood of developing diabetes, independent of treatment. The small extra risk of type 2 diabetes with the long-term use of thiazide diuretics was reported in the 1960s when relatively high doses were used. It is re-emerging as a concern based on recent trials suggesting that a greater proportion of patients ha…
Prevention
- A prudent approach is to measure serum potassium, uric acid and fasting glucose before prescribing and not use diuretics (or beta blockers) if the fasting blood glucose is at, or above, 6.1 mmol/L. Fasting glucose should be monitored periodically in patients on continuing diuretic treatment.
Cost
- In the absence of major differences in efficacy, safety and convenience, comparative cost may become the final discriminator. In a Pharmaceutical Benefits Scheme (PBS) which is continually under threat, small differences in cost (to the taxpayer) in treating a condition which affects 10-15% of the population can add up to substantial sums, particularly as treatment is usually lifelong.
Society and culture
- The comparative cost to the PBS of representative drugs from the five classes of antihypertensive drugs is shown in Table 1. The table includes the dose ranges used in the major studies which showed the efficacy of the drugs in reducing cardiovascular events.
Contraindications
- There will always be the need to tailor treatment to the individual patient, and it will nearly always be inappropriate, for example, to give a patient with gout a diuretic or a patient with asthma a beta blocker. However, for most patients with uncomplicated hypertension low-dose thiazide-type diuretics should be first-line therapy.
Organizations
- Dr Hill was a member of the World Health Organization/International Society of Hypertension group which constructedthe 'Statement on management of hypertension'. ProfessorSmith was Chair of the Writing Group which assembledTherapeutic Guidelines: Cardiovascular, 2003. Neither has anaffiliation with any pharmaceutical company.