Which drugs classes are recommended for initial treatment of hypertension (high blood pressure)?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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If lifestyle modifications are insufficient to achieve the goal blood pressure (BP), there are several drug options for the treatment and management of hypertension. Based on the Seventh Report of the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the 2010 Institute for Clinical Systems Improvement (ICSI) guideline on the diagnosis and treatment of hypertension recommendations, thiazide diuretics were the preferred initial agents in the absence of compelling indications. [5]

However, the updated JNC 8 guidelines no longer recommend only thiazide-type diuretics as the initial therapy in most patients. According to the JNC 8 guidelines, angiotensin-converting enzyme inhibitors [ACEIs] /angiotensin receptor blockers [ARBs], calcium channel blockers [CCBs], and thiazide diuretics are equally efficacious in hypertensive non-black populations, whereas CCBs and thiazide diuretics are favored in black patients with hypertension. [10]

Compelling indications may include high-risk conditions that can be direct sequelae of hypertension (heart failure, ischemic heart disease, chronic kidney disease, recurrent stroke) or that are commonly associated with hypertension (diabetes, high coronary disease risk), as well as drug intolerability or contraindications. [5]

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