Treatment of hypertension should involve non-pharmacologic therapy (also called lifestyle modification) alone or in concert with antihypertensive drug therapy. The ACC/AHA Blood Pressure Guidelines address both areas. In addition, the AHA scientific statement (2019) on BP measurement concluded that validated oscillometric devices allow for accurate BP measurement in the outpatient setting and “may provide a more accurate measurement of BP than auscultation”
(See ‘Related ObG Entry’ below)
NOTE: Calculate 10-year risk of heart disease or stroke using the ASCVD algorithm published in 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk (see ‘Learn More – Primary Sources’ below)
Thiazide or thiazide-type diuretics
ACE (angiotensin-converting-enzyme) inhibitors
Caution: Do not combine with ARBs or direct renin inhibitor | Increased risk of hyperkalemia (watch for patients with CKD, on K+ supplements or sparing meds) | Risk for acute renal failure in patients with severe bilateral renal artery stenosis | Do not use in pregnancy | Do not use if patient has history of angioedema with ACE inhibitors
ARBs (Angiotensin II Receptor Blockers)
Caution: Do not combine with ACE or direct renin inhibitor | Increased risk of hyperkalemia (watch for patients with CKD, on K+ supplements or sparing meds) | Risk for acute renal failure in patients with severe bilateral renal artery stenosis | Do not use in pregnancy | Do not use if patient has history of angioedema with ARBs | Note: Patient with history of angioedema due to ACE inhibitor can start ARBs six weeks after ACE inhibitor has been stopped
CCB (Calcium Channel Blocker): Dihydropyridines
Caution: Avoid use in patients with heart failure/reduced ejection fraction (HFrEF) – amlodipine or felodipine may be used if required | Dose-related pedal edema is more common in women
Caution: Avoid routine use with beta blockers due to increased risk of bradycardia and heart block| Avoid in patients with HFrEF | Note drug interactions with diltiazem and verapamil (CYP3A4 major substrate and moderate inhibitor)
Complete list with dosing available in the guideline link (see ‘Learn More – Primary Sources’ below)
BP Target Goals
Monotherapy vs Combination Therapy
Race / Ethnicity
Diabetic Patients with Hypertension
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
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