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Guidelines on the choice of agents and how best to step up treatment for various subgroups in hypertension (high blood pressure) have changed over time and differ between countries. A Comparison of International Guidelines on Goal Blood Pressure and Initial Therapy for Adults With Hypertension (adapted from JNC 8 guidelines [ 1 ] )
[18] [19] [needs update] [20] High blood pressure affects 33% of the population globally. [9] About half of all people with high blood pressure do not know that they have it. [9] In 2019, high blood pressure was believed to have been a factor in 19% of all deaths (10.4 million globally). [9] Video summary
For mild blood pressure elevation, consensus guidelines call for medically supervised lifestyle changes and observation before recommending initiation of drug therapy. However, according to the American Hypertension Association, evidence of sustained damage to the body may be present even prior to observed elevation of blood pressure.
For most people, recommendations are to reduce blood pressure to less than or equal to somewhere between 140/90 mmHg and 160/100 mmHg. [2] In general, for people with elevated blood pressure, attempting to achieve lower levels of blood pressure than the recommended 140/90 mmHg will create more harm than benefits, [3] in particular for older people. [4]
Serious side effects may include low blood pressure, kidney problems, allergic reactions, and electrolyte problems. [1] Use in pregnancy and breastfeeding is not recommended. [ 3 ] Losartan works by blocking the effects of angiotensin II while hydrochlorothiazide works by decreasing the ability of the kidneys to absorb electrolytes.
It may be used alone or in addition to other blood pressure medication. [4] Up to six weeks may be required for the full effects to occur. [4] Common adverse effects include muscle cramps, stuffy nose, dizziness, cough, high blood potassium, and anemia. [4] Severe adverse effects may include angioedema, low blood pressure, and kidney problems. [4]
Hydrochlorothiazide, sold under the brand name Hydrodiuril among others, is a diuretic medication used to treat hypertension and swelling due to fluid build-up. [4] Other uses include treating diabetes insipidus and renal tubular acidosis and to decrease the risk of kidney stones in those with a high calcium level in the urine. [4]
Metoprolol, sold under the brand name Lopressor among others, is a medication used to treat angina, high blood pressure and a number of conditions involving an abnormally fast heart rate. [4] It is also used to prevent further heart problems after myocardial infarction and to prevent headaches in those with migraines . [ 4 ]
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