2.14 Blood Pressure Control Medication

Diabetes planned visits address several health topics of concern to the diabetic patient, including high blood pressure. This document, created by the Summa Health System, provides an overview of available blood pressure medications and Medicaid coverage.
Medicaid Coverage/
Summa Tier
Medication/Dose AvailabilityTitration Schedule
ACE
Medicaid covers
Summa Tier 1
Captopril (Capoten)
12.5mg, 25mg, 50mg, 100mg
 
Start 12.5mg Q 8H,
Increase every two weeks
25mg Q 8H, 50mg Q 8H, 75mg Q8H, 100mg Q8H, 125mg Q8H,
MAX 150mg Q 8H
Goal DM nephropathy
25mg Q 8H
GFR <50 give Q 12H
Medicaid covers
Summa Tier 1
Enalapril (Vasotec)
2.5mg, 5mg, 10mg, 20mg 40mg
 
Start 5 mg QD
Increase Q 2 weeks
10mg QD, 20mg QD, 30mg QD
Max 40mg daily
Medicaid covers
Summa Tier 1
Lisinopril (Zestril, Prinivil)
2.5mg, 5mg, 10mg, 20mg, 40mg
 
Start 5mg QD
Increase Q 2 weeks
10mg QD, 20mg QD, 40mg QD
Max 80mg QD
Not covered Medicaid
Summa Tier 3
Quinapril (Accupril)
5mg, 10mg, 20mg, 40mg
 
Start 10mg QD
Increase Q 2 weeks
20mg QD, 40mg QD
Max 80mg QD
Not covered Medicaid
Summa Tier 3
Ramipril (Altace)
1.25mg, 2.5mg, 5mg, 10mg
 
Start 2.5mg QD
Increase Q 2 weeks
5mg QD, 10mg QD, 15mg QD,
Max 20mg QD
GFR <40
Max 5mg daily
Medicaid covers
Summa Tier
Benazepril (Lotensin)
5mg, 10mg, 20mg, 40mg
 
Start 10mg QD
Increase Q 2 weeks
20mg QD, 40mg QD
Max 80mg QD
ARB
Medicaid covers
Summa Tier 3
Candesartan (Atacand)
4mg, 8mg, 16mg, 32mg
 
Start 8mg QD
Increase Q 2 weeks
16mg QD, 24mg QD
MAX 32mg QD
Not covered Medicaid
Summa Tier 3
Eprosartan (Teveten)
400mg, 600mg
 
Start 400 mg QD
Increase to 800mg QD in 2 weeks
Max 800 mg daily
Not covered Medicaid
Summa Tier 3
Telmisartan (Micardis)
20mg, 40mg, 80mg
 
Start 20mg QD
Increase Q 2 weeks
40mg QD, 60mg QD
Max 80mg QD
Medicaid covers
Summa Tier 2
Losartan (Cozaar) 25mg, 50mg, 100mg 
Start 25mg QD
Increase Q 2 weeks
50mg QD,
Max 100mg QD
Not covered Medicaid
Summa Tier 3
Irbesartan (Avapro)
75mg, 150mg, 300mg
 
Start 75mg QD
Increase Q 2 weeks
150mg QD,
Max 300mg daily
Goal DM nephropathy 300mg
Medicaid covers
Summa Tier 3
Valsartan (Diovan)
40mg, 80mg, 160mg, 320mg
 
Start 40mg QD
Increase Q 2 weeks
80mg QD, 160mg QD,
Max 320mg daily
Goal LV dysfunction
160mg BID
Medicaid covers
Summa Tier 2
Olmesartan (Benicar)
5mg, 20mg, 40mg
 
Start 10mg QD
Increase Q 2 weeks
20mg QD,
Max 40mg
Calcium Channel Blocker (CCB)
Non-dihydropyridineVerapamil SR
(Calan, Verelan, Isoptin, Covera)
120mg, 180mg, 240mg
Preferred CCB in DM

Start 120 mg QD
Increase Q 1-2 weeks

Contraindicated in 2nd or 3rd degree AV block, Severe LV dysfunction, CHF

240mg QD, (dose >240mg may only increase side effects) 360mg QD,
Max 480mg QD
Diltiazem SR
(Cardizem, Tiazac, Dilacor)
120mg, 180mg, 240mg, 300mg, 360mg, 420mg
 
Start 120mg QD
Increase Q 1-2 weeks
240mg QD, 360mg QD,
Max 480mg QD
Dihydropyridine  
Medicaid covers
Summa Tier 1
Nifedipine ER
(Procardia, Adalat)
 
Start 30mg daily
Increase Q 1-2 weeks
60mg, 90mg (dose > 90mg may only increase side effects)
Max 120mg
Not covered Medicaid
Summa Tier 2
Amlodipine (Norvasc)
5mg, 10mg
 
Start 5mg
Increase in 1-2 weeks
Max 10mg
Medicaid covers
Summa Tier 2
Felodipine (Plendil) CR 
Start 5mg QD
Increase Q 1-2 weeks
10mg QD, 15mg QD,
Max 20mg QD
Medicaid covers
Summa Tier 1
Nicardipine (Cardene)
30mg, 45mg, 60mg
 
Start 30mg BID
Increase Q 1-2 weeks
45mg BID,
Max 60mg BID
Not covered Medicaid
Summa Tier 3
Isradipine (DynaCirc)
5mg, 10mg
Max 20mg QD
Start 5mg QD
Increase Q1-2 weeks
10mg, 15mg
Max 20mg
Medicaid covers
Summa Tier 3
Nisoldipine (Sular)
20mg, 30mg, 40mg
 
Start 20mg QD
Increase Q1-2 weeks
40mg QD (dose >40mg may only increase side effects)
Max 60mg
Beta Blockers
Medicaid covers
Summa Tier 1
Atenolol (Tenormin)
25mg, 50mg, 100mg
 
Begin 50 mg daily
Increase Q 2 weeks
100mg QD (dose above 100mg/day unlikely to lower BP)
Max 2oomg QD
Medicaid covers
Summa Tier 2
Carvedilol (Coreg)
3.125mg, 6.25mg, 12.5mg, 25mg
 
Start 3.125mg BID
Increase Q 2 weeks
6.25mg BID, 12.5mg BID,
Max 25mg BID
Medicaid covers
Summa Tier 1
Labetalol (Normodyne, Trandate)
100mg, 200mg, 300mg
DM may require higher dose
Start 100mg BID
Increase Q 2-3 weeks
200mg BID, 300mg BID, 400mg BID, etc
Max 1,200mg BID
Medicaid covers
Summa Tier 1
Metoprolol (Lopressor, ToprolXL)
25mg, 50mg, 100mg
 
Start 12.5mg (1/2 tablet) BID25mg BID, 50mg BID, 75mg BID, 100mg BID, 150mg BID, 200mg BID
Max 225mg BID
Page last reviewed January 2008
Internet Citation: 2.14 Blood Pressure Control Medication. January 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/diabnotebk/diabnotebk214.html