First-Line Therapy for Hypertension

Key Players in Medication Choices

• Understanding key classes of medications is essential for managing hypertension.

General Guidelines for First-Line Therapy

• Patient Characteristics and Comorbidities: Consider unique patient situations and histories when prescribing.
• Common First-Line Agents:
  • Thiazides
  • Calcium Channel Blockers
  • ACE Inhibitors (ACE-I)
  • Angiotensin Receptor Blockers (ARBs)

Thiazides

• Often the first choice for hypertension.
• Better at preventing heart failure compared to calcium channel blockers.
• Consider for patients with good lifestyle choices and low sodium intake.

ACE Inhibitors and ARBs

• Patients who require medication despite lifestyle changes may respond better to these options.
• Recommended for:
  • Patients with albuminuria (slow progression and preserve kidney function).
  • Patients with chronic kidney disease.

Beta Blockers

• No longer recommended as a first choice for the general population.

Special Populations

• Diabetic Patients:

  • Same first-line options as the general population.
  • ACE-I or ARB preferred if albuminuria is present.

• Black Patients:

  • Recommended first-line therapies: Thiazides or Calcium Channel Blockers.
  • ACE-I and ARBs less effective at preventing stroke compared to thiazides or CCBs.

• Combination Therapy:

  • If starting two agents: ACE-I or ARB with Thiazide or CCB.
  • Avoid RAS inhibitors as a single agent, even in diabetic patients.

• Pregnancy Considerations:

  • Limited options: Calcium Channel Blockers (e.g., Nifedipine) or Beta Blockers (e.g., Labetalol).
  • Avoid ACE-I and ARBs.

• Recent Myocardial Infarction or Heart Failure:

  • First choice: Beta Blocker.
  • Followed by ACE-I or ARB.

• Stable Coronary Artery Disease:

  • First: ACE-I or ARB.
  • Then consider Beta Blocker or CCB.

Gender Differences in Treatment

• No significant differences in antihypertensive treatments or blood pressure targets between males and females.
• Some studies indicate side effects may be more common in women.

Additional Resources

• Encouragement to check out the course for further learning and a free trial account for access to chapters.