What are the treatment guidelines for Hypertension (HTN)?

From the Guidelines

The primary goal of hypertension (HTN) treatment is to lower blood pressure to below 130/80 mmHg for most adults, and the most recent guidelines recommend starting with lifestyle modifications and pharmacological treatment with a single medication, typically from one of the following classes: thiazide diuretics, ACE inhibitors, angiotensin receptor blockers (ARBs), or calcium channel blockers 1.

Treatment Approach

For pharmacological treatment, the following medications are recommended:

• Thiazide diuretics (e.g., chlorthalidone 12.5-25 mg daily)
• ACE inhibitors (e.g., lisinopril 10-40 mg daily)
• Angiotensin receptor blockers (ARBs) (e.g., losartan 25-100 mg daily)
• Calcium channel blockers (e.g., amlodipine 2.5-10 mg daily) If blood pressure remains uncontrolled after 2-4 weeks, increasing the dose or adding a second medication from a different class is recommended. For resistant hypertension, consider adding a third medication or consulting a specialist 1.

Lifestyle Modifications

Lifestyle modifications are essential for all patients, including:

• A low-sodium diet
• Regular exercise
• Weight loss if overweight
• Limiting alcohol intake
• Smoking cessation These modifications can help achieve better blood pressure control and reduce cardiovascular risk.

Monitoring and Adjustment

Patients should be monitored regularly, checking blood pressure and assessing for side effects. Treatment should be adjusted as needed based on individual response and tolerability. The goal is to achieve a blood pressure below 130/80 mmHg while minimizing side effects and improving quality of life 1.

From the FDA Drug Label

Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake Many patients will require more than one drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)

The treatment guidelines for Hypertension (HTN) involve:

• Comprehensive cardiovascular risk management
• Control of high blood pressure through
  • Lipid control
  • Diabetes management
  • Antithrombotic therapy
  • Smoking cessation
  • Exercise
  • Limited sodium intake
• Many patients may require more than one drug to achieve blood pressure goals
• For specific advice on goals and management, refer to published guidelines such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) 2 3

From the Research

Treatment Guidelines for Hypertension (HTN)

The treatment guidelines for hypertension (HTN) involve a combination of lifestyle modifications and medication. The following are some of the key recommendations:

• Lifestyle modifications are recommended as the first-line treatment for hypertension, including:
  • Diet adaptation, such as the Dietary Approaches to Stop Hypertension (DASH) diet 4, 5, 6
  • Sodium reduction 4, 5, 6, 7
  • Alcohol restriction 4, 5, 6, 7, 8
  • Physical exercise 4, 5, 6, 7, 8
  • Weight reduction 4, 5, 6, 7, 8
• Medication is recommended for patients who do not respond to lifestyle modifications or who have high-risk factors, including:
  • Thiazide or thiazide-like diuretics 5, 6
  • Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 5, 6
  • Calcium channel blockers 5, 6
• The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk 5
• The target blood pressure goal is less than 130/80 mm Hg for adults under 65 years and less than 130 mm Hg for adults 65 years and older 5

Special Considerations

• For patients with chronic kidney disease, a blood pressure goal of less than 140/90 mm Hg is recommended 6
• For patients with diabetes mellitus, a blood pressure goal of less than 140/90 mm Hg is recommended 6
• Black patients with chronic kidney disease may benefit from treatment with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to a blood pressure of less than 140/90 mm Hg 6

Lifestyle Modifications

• Lifestyle modifications can be used as a first-line treatment for patients with high-normal blood pressure or grade 1 hypertension without high-risk factors, for a period of 3-6 months 4
• Lifestyle modifications can also enhance the effects of antihypertensive therapy in patients who require medication 4, 5