What is the appropriate initial therapy for individuals with diagnosed hypertension?
Initial therapy is predicated on age, ethnicity, body habitus, and kidney function. Comorbid conditions may also mandate specific agents as particular classes offer additional salutary effects more than those attributable to BP lowering alone.
As outlined above, easily correctable causes of hypertension, such as diet, sleeping habits, and medications, should be addressed. Thereafter, among otherwise healthy individuals with persistent stage I hypertension, monotherapy with either a calcium channel blocker, thiazide-like diuretic (chlorthalidone, indapamide), or a blocker of the renin-angiotensin system are considered first-line therapies. Those with diabetic nephropathy or heart failure should receive ACEi iARB therapy. β-blockers are not indicated for BP-lowering therapy, but they are the preferred agents for those with heart failure, arrhythmia, or recent myocardial infarction.
