What are the JNC 8 recommendations for dosing anti-hypertensive drugs?
Strategy A: Start with one drug (thiazide, CCB, ACEI, or ARB) and if the goal is not reached with the initial drug, increase the dose to the maximum or until the goal is reached. If the goal is not reached, add a second drug from a different class than the initial one (thiazide, CCB, ACEI, or ARB) and increase its dose until the goal is reached. If the goal is not reached with 2 drugs, add a third from the list and titrate the dose, avoiding the combination of ACEI and ARB.
Strategy B: Start with one drug and add a second before reaching the maximum dose of the first. Then titrate both doses until the goal is reached. If the goal is not reached with 2 drugs, select a third different drug (thiazide, CCB, ACEI, or ARB), avoiding the combination of ACEI and ARB. Titrate the third drug until the goal is reached.
Strategy C: Initiate therapy with 2 drugs simultaneously, either separated or combined in a tablet. Some recommend initiating with 2 drugs when SBP > 160 mm Hg and/or DBP > 100 mm Hg. If the goal is not reached with 2 drugs, select a third different drug (thiazide, CCB, ACEI, or ARB), avoiding the combination of ACEI and ARB. Titrate the third drug until the goal is reached.