Pharmacological Strategies

If the target 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.17 Beta1-adrenergic receptor blocking agents are no longer recommended as first-line therapy. Since more than two-thirds of patients with HTN do not adequately respond to mono-drug therapy, especially if the BP is 20/10 mmHg above goal, many require treatment with two or more agents from different antihypertensive classes. The efficacy of the initial drug therapy is closely monitored and adjusted as necessary until the target BP is achieved. After the target BP is achieved, follow-up visits are usually scheduled at 3- to 6-month intervals.