Hypertension in Adults: Initial Management

Vocabulary practice flashcards covering diagnostic staging, drug selection guidelines, combination therapies, trial evidence, and clinical recommendations for the initial management of adult hypertension.

Normal Blood Pressure

A blood pressure category defined by an office systolic blood pressure of $<120\,\text{mmHg}$ and a diastolic blood pressure of $<80\,\text{mmHg}$.

Elevated Blood Pressure

A blood pressure category defined by a systolic blood pressure of $120\text{ to }129\,\text{mmHg}$ and a diastolic blood pressure of $<80\,\text{mmHg}$.

Stage 1 Hypertension

A blood pressure category defined by an office systolic blood pressure of $130\text{ to }139\,\text{mmHg}$ or a diastolic blood pressure of $80\text{ to }89\,\text{mmHg}$.

Stage 2 Hypertension

A blood pressure category defined by an office systolic blood pressure of $\ge 140\,\text{mmHg}$ or a diastolic blood pressure of $\ge 90\,\text{mmHg}$.

Severe Hypertension

A blood pressure elevation defined by a systolic blood pressure of $>180\,\text{mmHg}$ or a diastolic blood pressure of $>120\,\text{mmHg}$, requiring urgent evaluation to exclude acute target-organ damage.

Single-Pill Combination (SPC)

A fixed-dose oral formulation containing two or more antihypertensive medications within a single pill, shown to improve therapeutic adherence and blood pressure control compared with separate tablets.

Free Equivalents

An antihypertensive regimen in which two or more medications are prescribed and administered as separate individual tablets rather than combined in a single pill.

Preferred Antihypertensive Drug Classes

The three first-line drug classes recommended for initial therapy: angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide diuretics.

ACCOMPLISH Trial

A clinical trial of $11{,}506$ high-risk hypertensive patients demonstrating that combining an ACE inhibitor with a dihydropyridine CCB (benazepril-amlodipine) provided superior reduction in cardiovascular events and kidney disease progression compared to benazepril-hydrochlorothiazide.

Thiazide-like Diuretics

Agents including chlorthalidone and indapamide that exhibit greater potency and longer durations of action ($24\,\text{hours}$ or more vs. $6\text{ to }12\,\text{hours}$) compared with the thiazide-type diuretic hydrochlorothiazide.

PREVENT Tool

The Predicting Risk of cardiovascular disease EVENTs tool used to estimate 10-year risk of atherosclerotic cardiovascular disease (ASCVD); a calculated risk of $\ge 7.5\%$ warrants initiating drug therapy in stage 1 hypertension.

Dual Renin-Angiotensin System Blockade

A contraindicated combination therapy consisting of an ACE inhibitor with an ARB or a direct renin inhibitor, associated with increased adverse cardiovascular and renal events without additional benefit.

Beta Blocker and Nondihydropyridine CCB Combination

A potentially hazardous combination of a beta blocker with diltiazem or verapamil that must be avoided due to additive negative inotropic and chronotropic cardiac effects.

Alpha-1 Adrenergic Blocker and Clonidine Combination

A drug combination to avoid because it offers minimal antihypertensive efficacy and creates a heightened risk of significant orthostatic hypotension.

Beta Blocker and Clonidine Combination

A drug regimen to avoid due to inferior efficacy relative to other combinations and an increased risk of severe bradycardia, hypotension, and arrhythmias.

Chronic Kidney Disease with Albuminuria

A condition characterized by an eGFR of $<60\,\text{mL/min/1.73 m}^2$ and/or urine albumin-to-creatinine ratio of $\ge 300\,\text{mg/g}$, indicating preferential first-line treatment with an ACE inhibitor or ARB to prevent progression to end-stage kidney disease.

Initial Monotherapy Indications

The strategy of starting a single agent (ACE inhibitor, ARB, or dihydropyridine CCB), indicated for stage 1 hypertension with cardiovascular risk factors, or for stage 2 patients who are frail, aged $>75\,\text{years}$, or prone to adverse drug effects.

Lifestyle Modifications for Hypertension

Comprehensive nonpharmacologic measures recommended for all patients, comprising the DASH diet, reduced sodium intake, increased potassium intake, aerobic exercise, weight loss, smoking cessation, and alcohol moderation.

Teratogenic Antihypertensive Classes

Medication classes contraindicated in individuals who may become pregnant due to potential fetal harm, specifically ACE inhibitors, ARBs, mineralocorticoid receptor antagonists, and direct renin inhibitors.

Preferred Antihypertensives in Potential Pregnancy

Agents with established fetal safety profiles appropriate for individuals who may become pregnant, including dihydropyridine CCBs (nifedipine extended release, amlodipine), labetalol, carvedilol, and metoprolol.

TIME Trial

A prospective randomized trial of over $21{,}000$ hypertensive adults that established that morning versus bedtime dosing of antihypertensive medications produces no difference in cardiovascular outcomes or safety.

Race-Agnostic Hypertension Therapy

An evidence-based approach implementing guideline-concordant combination therapy (ACE inhibitor or ARB plus CCB or diuretic) regardless of patient race, reducing therapeutic inertia and racial disparities in blood pressure control.

Antihypertensive Tapering

A gradual step-down and potential cessation of medication doses over several weeks, considered in select patients with blood pressure controlled at goal for at least one year and ongoing adherence to substantive lifestyle modifications.

Algorithm 1: Selection of Initial Antihypertensive Therapy

A clinical flowchart guiding initial antihypertensive therapy based on blood pressure thresholds (stage 1, stage 2, or severe hypertension), ASCVD risk score, and comorbid clinical conditions.

Table 4: Preferred Single-Pill Combinations (Adult Dosing)

A clinical reference table outlining adult daily dosing ranges (low, moderate, and high dose) for single-pill combinations of ACE inhibitors or ARBs combined with thiazide diuretics or dihydropyridine calcium channel blockers.