For patients younger than 60 years, clinicians should initiate pharmacologic treatment if diastolic blood pressure is 90 mmHg or higher. For patients with chronic kidney disease or diabetes, antihypertensive drugs should be used when systolic blood pressure is 140 mmHg or higher, or when diastolic blood pressure is 90 mmHg or higher.

Patients who are not African American, including those with diabetes, should receive a thiazide-type diuretic, a calcium channel blocker, an angiotensin converting enzyme inhibitor (ACE inhibitor), or an angiotensin receptor blockers (ARB) as initial therapy. Initial therapy for African American patients should include only a thiazide-type diuretic or a calcium channel blocker. Those with chronic kidney disease should receive initial or add-on antihypertensive treatment with an ACE inhibitor or an ARB, regardless of race or diabetes status.


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If target blood pressure is not reached within 1 month of antihypertensive therapy, increase the dose of the initial drug, or add a second drug from 1 of these classes: thiazide-type diuretic, calcium channel blocker, ACE inhibitor, or ARB.

Blood pressure should be monitored continually; the treatment regimen should be adjusted until target blood pressure is reached. A third drug can be added and titrated if goal blood pressure cannot be attained with 2 drugs.

Clinicians should not use an ACE inhibitor and an ARB together.                                      

Reference

  1. What are the key statistics about kidney cancer? American Cancer Society website. http://www.cancer.org/cancer/kidneycancer/detailedguide/kidney-cancer-adult-key-statistics. Updated February 10, 2016. Accessed September 1, 2016.
  2. Maitland ML, Bakris GL, Black HR, et al. Initial assessment, surveillance, and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors. J Natl Cancer Inst. 2010;102(9):596-604.
  3. de Souza VB, Silva EN, Ribeiro ML, Martins W de A. Hypertension in patients with cancer. Arq Bras Cardiol. 2015;104:246–252.
  4. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-2572.
  5. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520.