Fig. 2

Stepwise antihypertensive therapy for hypertension: strategies for achieving target blood pressure. *1: For patients aged ≥75 years or with impaired renal function (CKD stage 4 or eGFR <30 mL/min/1.73 m²), treatment should generally be initiated at half the standard dose of monotherapy. *2: ARNI should not be used concomitantly with ACE inhibitors. A washout period of at least 36 h is required when switching from an ACE inhibitor to an ARNI. According to the product label, ARNI should not be used as the initial drug for antihypertensive therapy in principle. *3: Loop diuretics are preferred in patients with eGFR <30 mL/min/1.73 m². *4: ARNI and MR antagonists may be used as alternatives given their natriuretic effects. *5: Evaluate and address factors affecting lifestyle modifications and medication adherence, such as adverse effects or polypharmacy. ARB angiotensin II receptor blocker, ARNI angiotensin receptor–neprilysin inhibitor, ACE angiotensin-converting enzyme, BP blood pressure, CKD chronic kidney disease, eGFR estimated glomerular filtration rate, MR mineralocorticoid receptor. Translated and adapted from ref. [2]