What is often the first-line treatment for hypertension in the absence of heart failure?

The first-line treatment for hypertension in the absence of heart failure is often ACE inhibitors. Angiotensin-converting enzyme (ACE) inhibitors are favored because they not only help in lowering blood pressure effectively but also provide additional benefits related to cardiovascular protection and kidney function. They work by inhibiting the conversion of angiotensin I to angiotensin II, which leads to vasodilation, decreased blood volume, and lower systemic vascular resistance, all contributing to reduced blood pressure.

In clinical practice, guidelines recommend ACE inhibitors for many patients with primary hypertension, particularly those with conditions such as diabetes or chronic kidney disease, due to their protective effects on renal function and cardiovascular risk reduction. They are generally well-tolerated and can be used alongside other antihypertensive agents if necessary to achieve optimal blood pressure control.

While diuretics are commonly used, especially in cases where there is volume overload or in the elderly, they are not typically the first choice for initial monotherapy in younger patients or those without heart failure. Beta-blockers had historically been used more frequently but are now often reserved for specific cases, such as patients with a history of myocardial infarction or certain arrhythmias. Calcium channel blockers are effective and can be a good alternative but are not