Hypertension

Use at a glance

• Confirm persistent HTN + assess CV risk

Treatment options

• First-line: ACEi/ARB, DHP CCB, thiazide
• Beta blockers not routine first-line alone

Other treatment options

• Many need 2 drugs from the start
• Albuminuric CKD → ACEi/ARB favored
• CAD/HFrEF/AF may dictate other choices

Choosing treatment

• Resistant HTN: add an MRA if appropriate

Key points

• Goal BP <130/80 mm Hg
• BP 130–139/80–89: treat if ≥65, ASCVD or 10-yr risk ≥10%, DM, CKD, HF
• SBP ≥140 or DBP ≥90 → drug therapy
• 1st-line: thiazide/thiazide-like, ACEi/ARB, CCB; mono or two-class combination
• ≥20/10 above goal → start 2 drugs; consider if ≥140/90
• Two low-dose drugs > one high-dose drug for efficacy, tolerability
• Beta blockers only with compelling indication (prior MI, HFrEF)

Nonpharmacologic therapies

• DASH diet
• Sodium restriction
• Alcohol limitation
• Structured exercise
• Dietary potassium
• Potassium chloride salt substitute
• Weight loss
• Renal denervation

Pearls

• Chlorthalidone ≈ HCTZ for outcomes; more hypokalemia, renal dysfunction
• Avoid MRAs in hypertension if eGFR <45
• Eplerenone: less gynecomastia than spironolactone
• DHP CCBs: edema, more in women; verapamil: constipation
• Avoid immediate-release nifedipine for hypertension

Self-check

• What is first-line treatment for Hypertension?
  ACEi/ARB, DHP CCB, thiazide.
• What is confirmed before hypertension treatment?
  Persistent HTN + assess CV risk.

Drugs used for this (70)

All clinical uses · Open Hypertension in the interactive console ↗