Starting drug therapy for blood pressure reduction

The main aim of drug therapy for elevated blood pressure (BP) is to prevent long-term complications (eg atherosclerotic cardiovascular disease [ASCVD], heart failure, kidney disease). Before starting drug therapy, confirm that elevated BP is not secondary to a treatable problem (see Secondary hypertension).

BP-lowering treatment can be started as either:

  • a single drug at a low or moderate dose
  • two drugs at a low dose; this approach is reasonable in all patients, especially those with high ASCVD risk or with particularly elevated BP1.

Patients with elevated BP commonly require 2 or more drugs to reach the BP target. Combination therapy is often more effective and associated with fewer adverse effects than monotherapyChow, 2021Williams, 2018.

The choice of drug depends on both drug and individual patient factors—see Drugs used for blood pressure reduction.

1 At the time of writing, fixed-dose combination products are not available on the Pharmaceutical Benefits Scheme (PBS) for initial treatment of elevated BP. See the PBS website for current information.Return