Pharmacological Treatment Options for Hypertension

First line agents:

Second line agents:

Combination Therapy Advantages:

Multiple medications are often required to reach target levels, especially in patients with Type 2 diabetes.
Reduce pill burden with single combination.
Lower doses of multiple drugs may be better tolerated than higher doses of fewer drugs.
STITCH trial: Larger BP reductions, more patients at target BP with fixed dose combo versus monotherapy

Treatment of Resistant Hypertension:

Referral suggested to a health care provider with expertise in diagnosis and management of hypertension.
Defined as BP above target despite > 3 BP lowering drugs at optimal doses.
Preferably includes a diuretic.

Strategies to Improve Adherence to Pharmacotherapy

Assist your patient by:

Tailoring pill-taking to fit patient’s daily habits.
Simplifying medication regimens to once-daily dosing.
Replacing multiple pill antihypertensive combinations with single pill combinations.
Using unit-of-use packaging (of several medications to be taken together).
Using a multidisciplinary team approach to improve adherence to an antihypertensive prescription.

Assist your patient in getting more involved in their treatment regimen by:

Encouraging greater patient responsibility/autonomy in monitoring their blood pressure and adjusting their prescriptions.
Educating patients and their families about their disease and treatment regimens.

Follow-up:

Assessing adherence to pharmacological and nonpharmacological therapy at every visit.
Encouraging adherence with therapy by out-of-office contact (either by phone or mail), particularly during the first three months of therapy.
Coordinating with health care team to improve monitoring of adherence with pharmacological and lifestyle. modification prescriptions
Utilizing electronic medication compliance aids.

Home Blood Pressure Monitoring:

Can be considered for ALL patients with hypertension, especially: Diabetes, Chronic kidney disease, Suspected non adherence, Demonstrated white coat effect, BP controlled in office, but not at home.
Requires adequate training.
Patient should be observed and given information about interpreting readings.

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