Pharmacological Strategies

If goal BP is not achieved by lifestyle modification alone, drug therapy is initiated with a thiazide diuretic, a calcium channel blocker, an angiotensin-converting enzyme inhibitor, or an angiotensin receptor blocker.16 Beta1-adrenergic receptor blocking agents are no longer recommended as first-line therapy. Since more than two-thirds of hypertensive individuals cannot be controlled on one drug alone, especially if the BP is 20/10 mmHg above goal, many patients require treatment with two or more agents from different antihypertensive classes. Once drug therapy is initiated, patients require follow-up and adjustment of medications at monthly intervals until the BP is at target. After the BP is at goal and stable, follow-up visits are usually at 3 to 6 month intervals.