Selection of initial antihypertensive therapy

This algorithm describes our approach to initial antihypertensive therapy. All patients with hypertension should receive education on lifestyle modifications, including reduced sodium intake, increased physical activity, and weight loss if overweight. Lifestyle modifications are continued even as antihypertensive drug therapy is added. Please refer to related UpToDate content for additional details.

ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker; ASCVD: atherosclerotic cardiovascular disease; CCB: calcium channel blockers; CKD: chronic kidney disease; DBP: diastolic blood pressure; PREVENT: Predicting Risk of cardiovascular disease EVENTs; SBP: systolic blood pressure; TIA: transient ischemic attack.

* The 10-year risk of ASCVD is estimated using the PREVENT calculator or another validated ASCVD risk assessment tool. Refer to related UpToDate content on cardiovascular disease risk assessment for further detail.

¶ Some experts prefer initial monotherapy, rather than combination therapy, for patients with systolic pressure of 140 to 145 mmHg and diastolic pressure <90 mmHg.

Δ Compared with giving 2 agents as separate pills, prescribing single-pill combination therapy improves adherence to therapy and increases attainment of blood pressure goals.

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Selection of initial antihypertensive therapy