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The recommended blood pressure goal is advised as <150/90 mmHg, with thiazide diuretic, CCB, ACEI, or ARB being the first-line medication in the United States. [42] In the revised UK guidelines, calcium-channel blockers are advocated as first line, with targets of clinic readings <150/90, or <145/85 on ambulatory or home blood pressure monitoring.
The 8th Joint National Committee (JNC-8) recommends calcium channel blockers to be a first-line treatment either as monotherapy or in combination with thiazide-type diuretics, ACEis, or ARBs for all patients regardless of age or race. [7] The ratio of CCBs' anti-proteinuria effect, non-dihydropyridine to dihydropyridine was 30 to −2. [13]
As diuretics proved equally effective and were cheaper, the Joint National Committee 7 guidelines of 2003, recommended diuretics as a first line treatment for hypertension. The study confirmed the previously held views that ACE inhibitors were less effective in blood pressure control and stroke prevention in men of African and Caribbean descent.
Documented goals for blood pressure include a reduction in the mean arterial pressure by less than or equal to 25% within the first 8 hours of emergency. [7] If blood pressure is lowered aggressively, patients are at increased risk of complications including stroke, blindness, or kidney failure. [6]
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]
Although evidence shows calcium channel blockers and thiazide-type diuretics are preferred first-line treatments for most people (due to both efficacy and cost), an angiotensin II receptor antagonist such as losartan is recommended as first-line treatment in people under the age of 55 who cannot tolerate an ACE inhibitor. [15]
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