There’s a step approach which means they’re on just ONE drug in Step 2. They’re on TWO drugs in Step 2 and so forth. Three drugs in Step 3 and, you guessed it, four drugs in Step 4.
How do we know which drug is the right Step 1 drug? We don’t know for sure. We try to treat a patient with one drug. If it doesn’t work, then we move on. It will be months and months between each step because the hypertensive consequences are not dire, but we need to get them under control.
If we use a beta blocker in Step 1, we’re not going to use a beta blocker in Step 2, we would instead choose a drug with a different mechanism of action.
Step 1: Beta blockers, diuretic, alpha adrenergic blocker, ACE inhibitor or calcium channel blocker.
Step 2: Sympatholytic, beta blocker, alpha adrenergic blocker, ACE inhibitor or calcium channel blocker.
Step 3. Vasodilator
Step 4: Sympatholytic (step 2 is sympatholytic also but this one uses guanethidine, which has more side effects)