AHA High Blood Pressure Toolkit

11 TREATMENT – PHARMACOLOGIC Antihypertensive Medication The BP threshold for antihypertensive medication should be determined on the basis of the average BP levels and CVD risk. BP Threshold (mm Hg) Patient Scenario ≥130/80 ASCVD risk of 10% or higher OR Clinical CVD ≥140/90 ASCVD risk less than 10% Four classes of oral antihypertensive drugs are recommended as first-line agents for the treatment of hypertension. • Thiazide or thiazide-type diuretics • Angiotensin-converting enzyme (ACE) inhibitors • Angiotensin receptor blockers (ARBs) • Calcium-channel blockers (dihydropyridines and nondihydropyridines) Six general classes of oral antihypertensive drugs are recommended as second-line agents. • Diuretics (loop, potassium sparing and aldosterone antagonists) • Beta-blockers (cardioselective, and vasodilatory, noncardioselective, intrinsic sympathomimetric activity and combined alpha- and beta-receptor) • Direct renin inhibitor • Alpha-1 blockers • Central alpha 2 -agonist and other centrally acting drugs • Direct vasodilators Oral Antihypertensive Drugs Simultaneous use of an ACE inhibitor, ARB and/or renin inhibitor is potentially harmful and is not recommended for the treatment of adults with hypertension. BP Status Recommended Follow-up/Reassessment Normal 1 year Elevated 3-6 months Stage 1 hypertension Monthly until BP goal met with BP lowering medication + nonpharmacologic interventions 3-6 months after BP goal met Stage 2 hypertension Monthly until BP goal met with BP lowering medication + nonpharmacologic interventions 3-6 months after BP goal met Follow-up Follow-up visits to reassess BP and monitor adherence and response to treatment should be regularly scheduled according to guideline recommendations. Use of self-monitoring, team-based care and telehealth strategies is recommended.