Weight loss and life style modification. Drug choice for treatment of hypertension is based on comorbidity. So best choice depends upon co-morbidities.

My personal preference is to use calcium channel blockers (CCB's) because they have anti-atherosclerotic properties and they dilate arteries, thus enhancing the lumen of a partially obstructed artery. The initial step in plaque formation, after LDL-c infiltration of the media is an influx of calcium, which is blocked by CCB's. The chief side-effect is peripheral edema, which is readily treated with low-dose diuretics. Watching dietary salt and increasing exercise is helpful as a adjunct as many patients don't follow through on these instructions.

I agree with William view. CCB are metabolically neutral drugs, so it can be used in any type of patients. For others we have to see the contraindications.

selection of medicine is solely based on urgency / emergencies of BP and associated co -morbidities . short act mg drugs used for acute situations and long acting for maintenance of BP

Great — here’s a concise, practical answer:

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There is no single “best” medicine for hypertension for everyone. The best choice depends on your individual situation — age, other medical conditions, kidney function, race/ethnicity, and potential side effects. But first-line choices for most people include:

✅ Thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone) – effective and inexpensive; especially good in older adults or African American patients.

✅ Calcium channel blockers (e.g., amlodipine, nifedipine) – often preferred if you have isolated systolic hypertension or can’t tolerate other drugs.

✅ ACE inhibitors (e.g., enalapril, lisinopril) or ARBs (e.g., losartan, valsartan) – especially if you have diabetes, chronic kidney disease, or heart failure.

💡 Key points:

For black patients without kidney disease, guidelines recommend starting with thiazide diuretics or calcium channel blockers.

In diabetics or chronic kidney disease, ACE inhibitors or ARBs help protect kidneys.

Combination therapy (using two drugs from different classes) is often needed if BP is >20/10 mmHg above target.

Lifestyle changes (diet, exercise, reducing salt) are just as important as medications.

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Best choice medicine depend on age and comorbidités of patients

Choice of therapy also depend upon the amount of BP above target. If it is >20/10 above the target we recommend dual combination therapy.

As far as medicine is concerned , ACE inhibitor is useful for Hypertension HF. other are ARB agents useful for HTN

Be careful of using short-acting drugs in people with known atherothrombotic plaque, lest the perfusion pressure go too low and the blood pressure is too low to per fuse the distal cardiac tissue, leading to myocardial infarction.

Stop all medications to save yopurself from side effects & adverse effects. Clinical yoga therapy has an answer to its permanent cure

Medicine choose on patients comborbidies and level of BP

Why to depend on medicines, which invariably damage our vital organs! Better to change lifestyle and adopt yoga therapy, mind control techniques etc.

We conducted a door-to-door observation and survey in a rural hill community to identify the most common health problems. Hypertension is found to be the one, especially among adult men. They come to town Govt. hospital for check-up and treatment. The CCBs are the most common prescriptions. The side-effects of CCBs such as dizziness, headache & bradycardia are found to be common discomforts most of them are experiencing, which are interfering with their daily livelihood-related works. Women doing household management are afraid of falling on the burning stove. General QOL is affected. They don't seek medical help till the problems become unbearable. What is the common alternative!

Life style modification along with medicine will be best choice

The side effects of CCB's depend on the CCB used. My patients don't have all of the side effects you noted. Short acting CCB's (which I never use) will give more side effects than the long acting CCB's.

Agree with Mr. Alok Kumar Bharti. But lifestyle modifications cannot be prescribed as a standardised protocol. Each individual's life situation is so very different, so the changes can be made by the individual himself, as per his facilities, availability, accessibility, social norms etc. We can do only counselling to guide his thoughts. In my experience its not necessary to take anti-hypertensive drugs whole life. There are complementary healthcare techniques, gaining popularity for prevention of illnesses, cure & rehabilitation.

The most important life-style change is to stop smoking cigarettes and in people of African descent, to lower salt intake. Otherwise, it's almost a waste of time.

Life style modification is the he best preventative way but DOC will be dependent on patients underlying associated pathology

Thank you Prof.William Feeman,Alok Kumar Bharti,Ratna Prakash,

Thank you Prof.Shailendra KUMAR Singh,Sushanta Barua