II. Protocol: Step 1 (Determine when and how to intervene)

III. Protocol: Step 2

  1. Consider Hypertension Combination Therapy
    1. For Refractory Hypertensive Populations
    2. Combination therapy to start appears to be more effective than starting with monotherapy
  2. Choose agents first based on comorbidity and cohort
    1. See Hypertension Management for Specific Comorbid Diseases
    2. See Hypertension Management for Specific Populations
  3. Monotherapy (when not otherwise directed by comorbidity or cohort)
    1. Standard initial monotherapy choices
      1. Diuretics (e.g. Hydrochlorothiazide)
        1. If Diuretic is not first, it should be second
        2. Excellent adjunct to other antihypertensives
        3. Better outcomes than Lisinopril and Amlodipine
          1. Reduced risk of CVA, MI, CHF over other agents
          2. (2002) JAMA 288:2981-97 [PubMed]
      2. ACE Inhibitor or Angiotensin Receptor Blocker
        1. Preferred first-line agent in age under 60 years old
      3. Calcium Channel Blockers
    2. Compelling reason for other antihypertensive
      1. AntiHypertensives for Specific Comorbid Diseases
      2. Antihypertensives for Specific Populations
    3. Agents to avoid for monotherapy
      1. Alpha blockers
      2. Hydralazine
      3. Minoxidil
      4. Beta Blocker
        1. Trend is to avoid Beta Blockers as first-line agents in uncomplicated Hypertension
        2. Reserve for patients with Coronary Artery Disease or Congestive Heart Failure
    4. Avoid if non-compliant (rebound Hypertension)
      1. Beta Blockers
      2. Clonidine

IV. Protocol: Step 3

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Ontology: Antihypertensive Agents (C0003364)

Definition (MEDLINEPLUS)

High blood pressure, also called hypertension, usually has no symptoms. But it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. If you cannot control your high blood pressure through lifestyle changes such as losing weight and reducing sodium in your diet, you may need medicines.

Blood pressure medicines work in different ways to lower blood pressure. Some remove extra fluid and salt from the body. Others slow down the heartbeat or relax and widen blood vessels. Often, two or more medicines work better than one.

NIH: National Heart, Lung, and Blood Institute

Definition (NCI) Any substance used in the treatment of acute or chronic hypertension regardless of pharmacological mechanism. Antihypertensive agents include diuretics, alpha-adrenergic and beta-adrenergic antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, ganglionic blockers, and vasodilator agents.
Definition (CSP) agent that reduces high blood pressure.
Definition (MSH) Drugs used in the treatment of acute or chronic vascular HYPERTENSION regardless of pharmacological mechanism. Among the antihypertensive agents are DIURETICS; (especially DIURETICS, THIAZIDE); ADRENERGIC BETA-ANTAGONISTS; ADRENERGIC ALPHA-ANTAGONISTS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; CALCIUM CHANNEL BLOCKERS; GANGLIONIC BLOCKERS; and VASODILATOR AGENTS.
Concepts Pharmacologic Substance (T121)
MSH D000959
SnomedCT 1182007, 372586001
LNC LP31453-1
English Agents, Antihypertensive, antihypertensive agent, Antihypertensive Drugs, Agents, Anti-Hypertensive, Anti Hypertensive Agents, Anti Hypertensive Drugs, Anti Hypertensives, Anti-Hypertensive Agents, Anti-Hypertensive Drugs, Anti-Hypertensives, Antihypertensives, Drugs, Anti-Hypertensive, Drugs, Antihypertensive, antihypertensives (medication), antihypertensives, anti hypertensive, antihypertensives drugs, anti hypertensive drug, anti-hypertensive drugs, hypotensive agent, antihypertensive drug, antihypertensive drugs, anti hypertensives, antihypertensive, antihypertensive agents, hypotensive agents, anti-hypertensives, anti hypertensive drugs, blood pressure lowering drug, Antihypertensive Agents, Antihypertensive medicines, Antihypertensive Medicines, High Blood Pressure Medicines, High blood pressure medicines, Blood Pressure Medicines, ANTIHYPERTENSIVES, Hypotensive agents, Antihypertensive drug, Antihypertensive, Hypotensive agent (product), Hypotensive agent (substance), Hypotensive agent, Antihypertensive agent, Antihypertensive agent, NOS, Antihypertensive drug, NOS, Hypotensive agent, NOS, Hypotensive Agents, Hypotensive Drugs, Hypotensives, Antihypertensive Agent
French Agents antihypertenseurs, Médicaments antihypertenseurs, Anti-hypertenseurs, Antihypertenseurs
Swedish Blodtryckssänkande medel
Czech hypotenzíva, antihypertenzíva, hypotonika
Finnish Verenpainelääkkeet
Italian Farmaci antiipertensivi, Antiipertensivi
Russian GIPOTENZIVNYE SREDSTVA, ANTIGIPERTENZIVNYE SREDSTVA, АНТИГИПЕРТЕНЗИВНЫЕ СРЕДСТВА, ГИПОТЕНЗИВНЫЕ СРЕДСТВА
Croatian ANTIHIPERTENZIVI
Polish Leki obniżające ciśnienie, Leki hipotensyjne, Leki przeciwnadciśnieniowe
Japanese 血圧下降剤, 降圧剤, 抗高血圧症薬, 抗高血圧薬, 血圧降下剤, 血圧降下薬, 降圧物質, 降圧薬
Spanish Antihipertensivos, Fármacos Antihipertensivos, Agentes Antihipertensivos, agente antihipertensivo, agente hipotensor (producto), agente hipotensor (sustancia), agente hipotensor, droga antihipertensiva
Norwegian Blodtrykkssenkende midler
Portuguese Agentes Anti-Hipertensivos, Fármacos Anti-Hipertensivos, Anti-Hipertensivos
German Antihypertonika, Blutdrucksenkende Mittel, Antihypertensiva