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Blood Pressure Testing
Hypertension Diagnosis
Symptoms & Causes
Complications
Treatment
Treatment Overivew
Lifestyle Treatment
Hypertension Medication
Medication Selection
Compelling Indications
Diuretics
Beta-Blockers
ACE Inhibitors
Angiotensin Blockers
Calcium Channel Blockers
Alpha Blockers
Alpha-Beta Blockers
Vasodilators
Preventing Hypertension
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Living With Hypertension
Hypertension in Women
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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.

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