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The first line of treatment for hypertension is identical to the recommended preventive lifestyle changes [13] and includes dietary changes, [14] physical exercise, and weight loss. These have all been shown to significantly reduce blood pressure in people with hypertension. [15]
[42] [43] Hydralazine and its derivatives are also used in the treatment of severe hypertension, although they should be avoided in emergencies. [43] They are no longer indicated as first-line therapy for high blood pressure due to side effects and safety concerns, but hydralazine remains a drug of choice in gestational hypertension. [42]
Low doses (50 mg or less) of hydrochlorothiazide as first‐line therapy for hypertension were found to reduce total mortality and cardiovascular disease events over a four-year study. [5] Hydrochlorothiazide appears be more effective than chlorthalidone in preventing heart attacks and strokes. [14]
A meta-analysis confirmed that ACE inhibitors are effective and certainly the first-line choice in hypertension treatment. This meta-analysis was based on 20 trials and a cohort of 158,998 patients, of whom 91% were hypertensive.
In general, the thiazides and thiazide-like diuretics reduce the risk of death, stroke, heart attack, and heart failure due to hypertension. [11] Clinical practice guidelines regarding the use of thiazides vary by geographic region. Guidelines in the United States recommend thiazides as a first-line treatment for hypertension (JNC VIII). [12]
“Lifestyle and dietary changes are definitely first line approaches, but when these fail to adequately control hypertension medication becomes necessary,” said Morales. “It really depends ...