Choosing a High Blood Pressure Medication

The following methodology for high blood pressure treatment is from the NIH (JNC 7 Express):

• Implement healthy lifestyle changes to lower high blood pressure naturally
• If not at goal blood pressure (<140/90 mmHg for normal patients or <130/80 mmHg for patients with diabetes or chronic kidney disease), make initial drug choices:
• With Compelling Indications
• Heart failure: treat high blood pressure with diuretic, beta-blocker, angiotensin converting enzyme (ACE) inhibitor, angiotensin receptor blocker, aldosterone antagonist
• Postmyocardial infarction: treat high blood pressure with beta-blocker, angiotensin converting enzyme (ACE) inhibitor, aldosterone antagonist
• High coronary disease risk: treat high blood pressure with diuretic, beta-blocker, angiotensin converting enzyme (ACE) inhibitor, calcium channel blocker, aldosterone antagonist
• Diabetes: treat high blood pressure with diuretic, beta-blocker, angiotensin converting enzyme (ACE) inhibitor, angiotensin receptor blocker, calcium channel blocker
• Chronic kidney disease: treat high blood pressure with angiotensin converting enzyme (ACE) inhibitor, angiotensin receptor blocker
• Recurrent stroke prevention: treat high blood pressure with diuretic, angiotensin converting enzyme (ACE) inhibitor
• Without Compelling Indications:
• Stage 1 Hypertension (systolic 140-159 or diastolic 90-99 mmHg): treat high blood pressure with Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination.
• Stage 2 Hypertension: (systolic ≥ 160 or diastolic ≥ 100 mmHg): treat high blood pressure with Two-drug combination for most (usually thiazidetype diuretic and ACEI, or ARB, or BB, or CCB).
• If blood pressure is not at goal after treatment with initial drug choices, optimize dosages or add additional drugs until goal blood pressure is achieved. Consider consultation with hypertension specialist.