What is the diagnosis and treatment for Hypertension (High Blood Pressure)?

From the Guidelines

Hypertension should be managed with a goal of maintaining blood pressure below 130/80 mmHg for most adults, using lifestyle modifications and medication as needed, prioritizing first-line medications such as thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers, as recommended by the most recent guidelines 1.

Key Considerations

• The definition of hypertension has been updated to 130/80 mmHg, which increases the number of adults diagnosed with hypertension 1.
• Lifestyle changes are essential and include reducing sodium intake, following the DASH diet, regular exercise, limiting alcohol consumption, maintaining healthy weight, and quitting smoking.
• First-line medications for hypertension include:
  • Thiazide diuretics (like hydrochlorothiazide 12.5-25 mg daily)
  • ACE inhibitors (such as lisinopril 10-40 mg daily)
  • ARBs (like losartan 25-100 mg daily)
  • Calcium channel blockers (amlodipine 5-10 mg daily)

Monitoring and Management

• Regular monitoring is crucial, ideally with home measurements in addition to clinical visits, as hypertension often has no symptoms but can lead to serious complications like heart disease, stroke, and kidney damage if left untreated 1.
• Treatment typically starts with a single medication at a low dose, increasing as needed, with additional medications added if blood pressure remains uncontrolled.
• The management of hypertension should be individualized, taking into account the patient's overall cardiovascular risk and other comorbid conditions, as recommended by recent guidelines 1.

From the FDA Drug Label

Aliskiren tablets are indicated for the treatment of hypertension in adults and in pediatric patients weighing 50 kg or greater who are at least 6 years of age and older to lower blood pressure. Losartan is indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older, to lower blood pressure.

The treatment of hypertension can be achieved with aliskiren or losartan.

• Aliskiren is indicated for adults and pediatric patients weighing 50 kg or greater who are at least 6 years of age and older.
• Losartan is indicated for adults and pediatric patients 6 years of age and older. Both drugs aim to lower blood pressure, which reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions 2 3.

From the Research

Definition and Prevalence of Hypertension

• Hypertension is defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg 4
• It affects approximately 116 million adults in the US and more than 1 billion adults worldwide 4

Risk Factors and Complications

• Hypertension is associated with increased risk of cardiovascular disease (CVD) events (coronary heart disease, heart failure, and stroke) and death 4
• An SBP reduction of 10 mm Hg decreases risk of CVD events by approximately 20% to 30% 4

Treatment and Management

• First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern that includes low sodium and high potassium intake, physical activity, and moderation or elimination of alcohol consumption 4, 5, 6, 7, 8
• The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk 4
• First-line drug therapy for hypertension consists of a thiazide or thiazidelike diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 4

Lifestyle Interventions

• Increasing physical activity has extensive benefits, including improving both blood pressure and blood cholesterol 5
• Applying lifestyle intervention in the form of a continuous care model may be recommended to reduce dietary sodium intake and mean systolic and diastolic BP in patients who are hypertensive 6
• Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, can help prevent and treat hypertension 7
• Pharmacists can play a role in managing patients' medications and lifestyle behaviors to help them manage hypertension 8