Taming High Blood Pressure

How doctors find the right mix of medications to treat hypertension

Julie Corliss
Harvard Health Publishing

By age 70, most adults — 70% or more — have high blood pressure (hypertension), defined as a consistent reading of 130/80 milligrams of mercury (mm Hg) or higher. Most of them need at least two blood pressure medications to keep their pressure under control — and up to 30% require three drugs. With more than 200 different blood pressure medications on the market, how do doctors select the right combination for each individual?

The most recent blood pressure guidelines feature detailed advice about hypertension treatment, which includes four classes of drugs deemed first-line options: angiotensin-receptor blockers, ACE inhibitors, calcium-channel blockers and diuretics. When deciding which drugs to prescribe, doctors consider many factors, including whether you have stage 1 or stage 2 hypertension and any heart-related health risks or diagnoses, such as diabetes or coronary artery disease.

“I also review my patient’s other health issues and ask about their daily lives, including what they do for a living and how much time they spend outdoors, since their answers may affect which blood pressure medications are best for them,” says Dr. Katherine Sakmar, assistant professor of medicine at Harvard Medical School and internist at Massachusetts General Hospital.

What is stage 1 hypertension treatment?

Stage 1 hypertension is defined as systolic blood pressure — the first number in the reading — of 130 to 139 or diastolic blood pressure — the second number — of 80 to 89. Incorporating lifestyle changes into your daily routine, such as eating a low-sodium, plant-forward diet and exercising regularly, can lower the number of medications you need.

“Choosing which drug to try first is highly individualized for each person,” Sakmar says. Fortunately, most of the effective first-line choices in the four classes below are available as inexpensive generics, she adds.

1 Angiotensin-receptor blockers

By blocking angiotensin, a hormone that causes arteries to constrict, these drugs help blood vessels remain relaxed. ARBs often are the first drug doctors prescribe for stage 1 hypertension treatment. They also help protect the kidneys, so they are recommended for people with kidney disease or diabetes.

Examples: Losartan, irbesartan, valsartan

2 ACE inhibitors

These drugs help blood vessels to relax and widen by inhibiting angiotensin. Many people tolerate these drugs well. But ARBs are just as effective and don’t cause the dry cough some people have when taking ACE inhibitors, Sakmar notes. So, doctors usually prescribe ARBs over ACE inhibitors in people newly diagnosed with hypertension.

Examples: Benazepril, enalapril, lisinopril

3 Calcium-channel blockers

By blocking calcium entering cells, these medicines help the heart relax and blood vessels widen. In younger people with mildly elevated blood pressure, Sakmar often starts with one of these. They have relatively few side effects; the most common is swelling in the lower legs. Calcium-channel blockers are also used to treat angina and abnormal heart rhythms.

Examples: Amlodipine, felodipine, nifedipine XR

4 Thiazide diuretics

Sometimes called “water pills,” these drugs help rid the body of excess salt and water. But the most common side effect, frequent urination, can be problematic, especially for people with urinary problems, Sakmar says. Thiazide diuretics also make people more sensitive to the sun and may raise the risk of skin cancer, so they’re not ideal for people who spend a lot of time outdoors. Diuretics are rarely used initially, but they can enhance the benefits of other blood pressure drugs.

Examples: Chlorthalidone, hydrochlorothiazide, indapamide

What is stage 2 hypertension treatment?

Stage 2 hypertension — a systolic reading of 140 or higher or a diastolic reading of 90 or higher — should generally be treated with at least two drugs. “Smaller doses of two or three medications tend to be more effective than a higher dose of a single one,” Sakmar says.

According to a 2025 scientific statement from the American Heart Association, using single-pill combinations — such as an ARB plus a calcium-channel blocker or diuretic — can help people reach their blood pressure targets faster. Compared with taking separate pills, combination pills also are linked to a lower risk of heart attack and stroke, fewer side effects, a better quality of life and lower costs.

Study: 81% of toddler foods are ‘ultra-processed

Drew Pittock
USA Today

More parents are beginning to scrutinize the foods they give their children early in life, and a new study suggests they’re right to do so.

A team of researchers at the University of Texas at Austin surveyed 21 grocery stores across Austin, Texas, and found that more than 80% of available toddler foods were ultra-processed.

Here’s what you should know about the study and what it means for toddler health in the United States.

Research

Two research scientists at the University of Texas at Austin visited 21 grocery stores around Austin, gathering photographs of 2,783 products billed as suitable for children ages 6 to 36 months.

They found 81% of the products were ultra-processed, according to criteria outlined in the Nova Food Classification System.

The framework splits foods into four groups — unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods — depending on the “nature, extent and purposes of the industrial processes they undergo” before winding up on someone’s kitchen table.

According to Erin A. Hudson, a UT Austin graduate student and science policy fellow with the American Society for Nutrition, her research underscores an important discrepancy in what parents think they’re feeding their children.

“Many parents may assume that products sold on the baby/ toddler food aisles of their grocery stores have to meet certain nutrient standards. Our findings highlight that half of the toddler foods available in local grocery stores do not,” Hudson said. “As a result, parents have to be vigilant in checking labels and ingredients to determine the nutrient content and processing level of products for their toddlers.”

WHO recommendations

The research team also found that foods on U.S. grocery store shelves fell short of a standard established by the World Health Organization.

In 2022, the WHO published a Nutrition and Promotion Profile Model for commercial foods intended for children aged 6-36 months. Of the nearly 2,790 products Hudson and her team surveyed, many failed to meet WHO nutrient standards, including:

• 17% for sugar
• 25% for sodium
• 11% for fat content
• 12% for energy density

Specifically, Hudson pointed to popular products such as fruit pouches (high in sugar), oat bars (high in sugar and calories), mac and cheese (high in sodium and fat), turkey sticks (high in sodium and fat), cheese puffs (high in calories) and peanut butter puffs (high in sodium, fat and calories).

Long-term effects

Ultra-processed foods, or UPFs, are factory-made formulations produced largely from refined ingredients, additives (including colorings and preservatives) and little-to-no whole foods. Using artificial flavors and sweeteners, these foods are designed for more palatable tastes and longer shelf life.

While the full extent of ultra-processed foods on the human body is still being researched, ingesting UPFs — including packaged meats like hot dogs and bologna — has been associated with more than 30 health conditions, such as Type 2 diabetes, heart diseases, mental health disorders and obesity.

What’s more, the researchers at UT Austin noted that “foods children consume during the toddler years can shape taste preferences and dietary habits that persist throughout childhood, influencing long-term health.”

“During these critical early years of development, most parents are trying to feed their children healthfully but may be challenged to do so by the toddler food products available in their grocery stores,” Hudson said.

New dietary guidelines

The U.S. Department of Health and Human Services under Secretary Robert F. Kennedy Jr. issued new dietary guidelines this year, urging Americans to eat less sugar while consuming more meat, full fat dairy, and other high-protein foods.

“Today, our government declares war on added sugar,” Kennedy said during a White House news briefing in January. “My message is clear: eat real food.”

But Hudson wants to see the government go further than mere guidelines.

“Warning labels on products exceeding nutrient thresholds could help parents navigate the toddler food environment and might encourage manufacturers to reformulate these products,” Hudson said.

Southwest Montana Health Care Directory