Initial Treatment for Stage 1 Hypertension

Immediate Pharmacologic Treatment

The American Diabetes Association recommends initiating single-drug antihypertensive therapy at the time of diagnosis for blood pressure 140/90 mmHg, which represents stage 1 hypertension, alongside lifestyle changes 1
For non-Black patients, the American Diabetes Association suggests starting with an ACE inhibitor or ARB, such as lisinopril 10 mg daily or losartan 50 mg daily 1
For Black patients, the American Diabetes Association recommends starting with a thiazide-like diuretic, such as chlorthalidone 12.5-25 mg daily, or a dihydropyridine calcium channel blocker, such as amlodipine 5 mg daily 1

The American Diabetes Association recommends reducing dietary sodium intake to <2,300 mg/day, ideally <2,000 mg/day, to help lower blood pressure 1
Increasing fruits and vegetables to 8-10 servings per day, emphasizing whole grains, low-fat dairy, and lean proteins, as part of the DASH diet pattern, can help reduce blood pressure 1
Regular aerobic exercise, such as at least 150 minutes/week of moderate-intensity activity, can provide additive blood pressure reductions 1

The American Diabetes Association recommends achieving target blood pressure within 3 months of initiating therapy 2
Reassessing blood pressure within 2-4 weeks after starting medication to evaluate response and check for adverse effects is crucial 2

If blood pressure remains uncontrolled on initial monotherapy, optimizing the dose of the initial medication to the maximum recommended dose is the first step 2
Adding a second agent from a different class, such as a calcium channel blocker or thiazide diuretic, if started on an ACE inhibitor, is the second step 1 2

For patients with diabetes, the American Diabetes Association recommends using ACE inhibitors or ARBs, especially if albuminuria is present, to help reduce blood pressure 1
Monitoring for hyperkalemia and renal function 2-4 weeks after initiation of ACE inhibitors or ARBs in patients with diabetes is essential 1