Blood Pressure-Lowering Medication → Treat ↑High BP

Approaches

• SPC - Single Pill Combination (Preferred)

  • Small to moderate doses of 2 BP meds are preferable to 1 medication at full dose

• Indication and Target

  Population	Threshold for therapy	Target for therapy
  1) ‣,

  2. ‣, or > 15% risk of CVD,
  3. Age > 75 | ≥ 130/80 | sBP ≤ 120 | | 4) ‣ | ≥ 130/80 | ≤ 130/85 | | Moderate-low risk population | ≥ 140/90 | ≤ 140/90 |

Medication Options

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First-Line Agents

• ACEi(-pril)
  • In general, ACEi > ARBs (stabilizes atherosclerotic plaque).
• ARB (-sartan)
  • 1st line in sBP-only HTN (commonly oder adult), and LVH
  • If need a second agent, combination of ACEi and ARB is not advised
• Thiazide-like Diuretics
  • Long-acting ( Chlorthalidone) > Short-acting
• CCB
  • Long-acting DHP-CCB (”ipine”)
  • Short-acting Nifedipine should NOT be used
• Beta Blocker (”-prolol”)
  • in < 60 yr and no DCHF

• All Med Options

Mechanism Table

| Anti-Hypertensive Mechansim | ACEi(-pril) | ARB (-sartan) | DHP-CCB (”ipine”) | Thiazide-like Diuretics | Beta Blocker (”-prolol”) | ‣ (Not FL) | ‣ (Not FL) | ‣ (Not FL) | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Vasodilation | ✔ | ✔ | ✔ | ✔ (chronic) | | | | | | Decrease volume overload | ✔ (aldo) | ✔ (aldo) | | | | ✔ | ✔ | | | Negative Inotrope | | | ✔ (act on myocyte) | | ✔ (by decreasing SNS) | | | | | Sympatholytic | | | | | ✔ (peripheral) | | | ✔ (central) |

Special Indications (+ Comobidity)

• In general, ACEi/ARB are good for first line, especially due to its renal-protective effect

  • Except in Pregnancy (Contraindicated → Malformation)

    

• First-line Treatment with other compiling indications (From HTN Canada)

Refractory Hypertension

• BP above target despite 3 medications
• R/o White Coat effect and medication adherence
• Consider causes of secondary HTN
• 4th line agents

Common Side Effects