References

Thiazide Diuretics. 2023. https://www.ncbi.nlm.nih.gov/books/NBK532918 (accessed 3 October 2023)

Beckett NS, Peters R, Fletcher AE. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008; 358:(18)1887-98 https://doi.org/10.1056/NEJMoa0801369

Burnier M, Egan BM. Adherence in Hypertension. Circ Res. 2019; 124:(7)1124-1140 https://doi.org/10.1161/CIRCRESAHA.118.313220

Carey RM, Calhoun DA, Bakris GL Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension. 2018; 72:(5)e53-e90 https://doi.org/10.1161/HYP.0000000000000084

Carey RM, Wright JT, Taler SJ, Whelton PK. Guideline-Driven Management of Hypertension: An Evidence-Based Update. Circ Res. 2021; 128:(7)827-846 https://doi.org/10.1161/CIRCRESAHA.121.318083

Cohen JB, Denker MG, Cohen DL, Townsend RR. Cardiovascular Events and Mortality in White Coat Hypertension. Ann Intern Med. 2019; 171:(8)603-604 https://doi.org/10.7326/L19-0524

Cuspidi C, Sala C, Tadic M, Grassi G. When Office Blood Pressure Is Not Enough: The Case of Masked Hypertension. Am J Hypertens. 2019; 32:(3)225-233 https://doi.org/10.1093/ajh/hpy183

ACE Inhibitors. 2023. https://www.ncbi.nlm.nih.gov/books/NBK430896 (accessed 3 October 2023)

Angiotensin II Receptor Blockers (ARB). 2023. https://www.ncbi.nlm.nih.gov/books/NBK537027/ (accessed 3 October 2023)

Essential Hypertension. 2023. https://www.ncbi.nlm.nih.gov/books/NBK539859/ (accessed 3 October 2023)

Mancia G, Kreutz R, Brunström M ESH Guidelines for the management of arterial hypertension. J Hypertens. 2023; https://doi.org/10.1097/HJH.0000000000003480

Calcium Channel Blockers. 2022. https://www.ncbi.nlm.nih.gov/books/NBK482473 (accessed 3 October 2023)

Medical Defence Union. Montgomery and informed consent. 2023. https://www.themdu.com/guidance-and-advice/guides/montgomery-and-informed-consent (accessed 3 October 2023)

Nayor M, Duncan MS, Musani SK Incidence of cardiovascular disease in individuals affected by recent changes to US blood pressure treatment guidelines. J Hypertens. 2018; 36:(2)436-443 https://doi.org/10.1097/HJH.0000000000001570

National Institute for Health and Care Excellence. Multimorbidity: clinical assessment and management. 2016. https://www.nice.org.uk/guidance/ng56 (accessed 31 October 2023)

National Institute for Health and Care Excellence. Chronic heart failure in adults: diagnosis and management. 2018. https://www.nice.org.uk/guidance/ng106 (accessed 3 October 2023)

National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management. 2019a. https://www.nice.org.uk/guidance/ng136 (accessed 3 October 2023)

National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. 2019b. https://www.nice.org.uk/guidance/ng133 (accessed 3 October 2023)

National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. 2021. https://www.nice.org.uk/guidance/ng203 (accessed 3 October 2023)

Neal B, MacMahon S, Chapman N Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Lancet. 2000; 356:(9246)1955-64 https://doi.org/10.1016/s0140-6736(00)03307-9

Nitzan M, Slotki I, Shavit L. More accurate systolic blood pressure measurement is required for improved hypertension management: a perspective. Med Devices (Auckl). 2017; 10:157-163 https://doi.org/10.2147/MDER.S141599

Spironolactone. 2023. https://www.ncbi.nlm.nih.gov/books/NBK554421 (accessed 3 October 2023)

Royal Pharmaceutical Society. Prescribing Competency Framework. 2021. https://www.rpharms.com/resources/frameworks/prescribing-competency-framework/competency-framework (accessed 3 October 2023)

Ruths S, Bakken MS, Ranhoff AH Risk of hip fracture among older people using antihypertensive drugs: a nationwide cohort study. BMC Geriatr. 2015; 15 https://doi.org/10.1186/s12877-015-0154-5

Williams B, MacDonald TM, Morant S Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet. 386:(10008)2059-2068 https://doi.org/10.1016/S0140-6736(15)00257-3

Wright JT, Williamson JD, Whelton PK A Randomized Trial of Intensive versus Standard Blood-Pressure Control. New England J Med. 2015; 373:(22)2103-2116 https://doi.org/10.1056/NEJMoa1511939

Xie X, Liu Y, Perkovic V Renin-Angiotensin System Inhibitors and Kidney and Cardiovascular Outcomes in Patients With CKD: A Bayesian Network Meta-analysis of Randomized Clinical Trials. Am J Kidney Dis. 2016; 67:(5)728-41 https://doi.org/10.1053/j.ajkd.2015.10.011

Yaxley JP, Thambar SV. Resistant hypertension: an approach to management in primary care. J Family Med Prim Care. 2015; 4:(2)193-9 https://doi.org/10.4103/2249-4863.154630

Medication for hypertension management

02 November 2023
Clinical Focus
02 November 2023
Volume 5 · Issue 11

Abstract

Hypertension is a major risk factor for cardiovascular disease, heart failure, vascular dementia and chronic kidney disease, and the management of hypertension combines both lifestyle and pharmacological interventions. Guidelines are available nationally and internationally to support these approaches to managing blood pressure and reducing cardiovascular risk. This article discusses the diagnosis and management of hypertension, along with the role of medication to lower blood pressure. Particular consideration is given to the place for different drug treatments based on their mode of action, specific indications and potential side effects. By the end of this article, readers should be able to review how different types of hypertension are diagnosed; compare national and international guidelines; consider the different types of medication most commonly used in hypertension; and evaluate the mode of action and how this influences indication for use and possible side effects.

According to the National Institute for Health and Care Excellence (NICE, 2019a), the definition of hypertension is ‘persistently raised arterial blood pressure’. However, use of the term ‘raised’ is open to interpretation, as the range of normal blood pressure (BP) readings in the general population is widely distributed, and comorbidities such as chronic kidney disease can affect recommended targets (NICE, 2021).

In its guideline on hypertension diagnosis and management, NICE states that exceeding an upper limit of 140 mmHg systolic BP and/or 90 mmHg diastolic BP is when a diagnosis of hypertension should be suspected. Home blood pressure monitoring is recommended as the preferred method of confirming the diagnosis. Wherever the BP is measured, and whoever is doing it, correct technique should be used and repeated measurements taken to confirm the accuracy of the readings (Nitzan et al, 2017).

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Hypertension
ACE inhibitors
Angiotensin receptor blockers
Beta blockers