38
Management
Obesity and Cardiovascular Disease
Medical Management of Hypertension
➤ Select an antihypertensive medication based on a compelling
indication. If there is no primary indication, then first-line
antihypertensive medications include thiazide diuretics, calcium
channel blockers, angiotensin-converting enzyme (ACE)
inhibitors, or angiotensin receptor blockers (ARBs).
➤ For individuals with diabetes or chronic kidney disease, consider
starting an ACE inhibitor or an ARB.
➤ β-blockers should be started as a first-line antihypertensive
medication only for individuals who have ischemic heart disease
or heart failure. Some β-blockers are associated with weight gain.
➤ Second-line antihypertensive medications include loop diuretics,
potassium-sparing diuretics, mineralocorticoid receptor
antagonists, direct renin inhibitors, α-blockers, and vasodilators.
➤ For stage 1 hypertension, initiation of a single antihypertensive
medication with dose titration is reasonable.
➤ For stage 2 hypertension, initiation of two first-line
antihypertensive medications is reasonable.
➤ With weight loss, monitor blood pressure closely and adjust
antihypertensive medications to prevent hypotension.
➤ Consider referral to cardiology if hypertension is not well
controlled despite titration of medications or concerns for
resistant hypertension.
➤ Consider referral to pediatric cardiology for treatment of
hypertension in children.
