Pharmacotherapy Decision Aids for the American Heart Association 2021 Statement on Management of Stage 1 Hypertension

This is a pragmatic decision aid for initiating pharmacotherapy for stage 1 hypertension.

If a stage 1 patient presents with clinical signs of fluid retention, then a diuretic should be the primary agent. However, if the patient is normovolemic, then a vasodilator should be the primary agent. If targeted blood pressure is not achieved with the primary agent, then the choices are dose escalation or the addition of a second drug. For stage 1, the addition of secondary agents is preferred. This approach includes the polypill (a single pill with multiple low-dose antihypertensive agents). The positives are the polypill lessens the need to make decisions associated with up-titration and the low doses mitigate adverse side effects. The polypill targets several concurrent mechanisms to counteract hypertension. For stage 1, the goal should be to lower blood pressure with a simple regiment which minimizes adverse side affects.