What are the standard operating procedures (SOPs) for managing hypertension?

From the Guidelines

All patients with hypertension should have an evidence-based care plan that includes lifestyle modifications and pharmacological treatment, with a goal of achieving a blood pressure of less than 130/80 mmHg, as recommended by the 2017 American College of Cardiology/American Heart Association hypertension guideline. The care plan should promote treatment and self-management goals, effective management of comorbid conditions, timely follow-up, and cardiovascular disease (CVD) guideline–directed management 1. Key components of the care plan include:

• Lifestyle modifications such as reduced sodium intake, regular physical activity, weight management, limited alcohol consumption, and a DASH diet rich in fruits and vegetables
• Pharmacological treatment with first-line medications including thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers
• Regular monitoring with follow-up every 2-4 weeks during dose adjustments and then every 3-6 months once blood pressure is controlled
• Emphasis on medication adherence and patient education about home blood pressure monitoring A team-based care approach is also recommended, which can include the use of electronic health records, patient registries, and telehealth strategies to improve hypertension control 1. The choice of antihypertensive medication should be based on the patient's individual characteristics, such as age, race, and comorbidities, and should target different physiological mechanisms of blood pressure regulation, including fluid volume, vascular resistance, and neurohormonal pathways. Overall, the goal of hypertension management is to reduce the risk of cardiovascular disease and improve patient outcomes, and this can be achieved through a comprehensive and evidence-based approach to care.

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 1 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 standard operating procedures (SOPs) for hypertension management include:

• Comprehensive cardiovascular risk management
• Lipid control
• Diabetes management
• Antithrombotic therapy
• Smoking cessation
• Exercise
• Limited sodium intake
• Following 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

Standard Operating Procedures (SOPs) for Hypertension

• Definition: Hypertension is defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg 4
• Prevalence: Hypertension affects approximately 116 million adults in the US and more than 1 billion adults worldwide 4, 5
• Risk Factors: Hypertension is associated with increased risk of cardiovascular disease (CVD) events and death 4, 6

Lifestyle Modifications

• First-line therapy for hypertension is lifestyle modification, including:
  • Weight loss 4, 6, 5
  • Healthy dietary pattern that includes low sodium and high potassium intake 4, 6, 5
  • Physical activity 4, 6, 5
  • Moderation or elimination of alcohol consumption 4, 6
  • Stress management and promotion of adequate sleep patterns coupled with circadian entrainment 5

Pharmacologic Therapy

• First-line drug therapy for hypertension consists of:
  • A thiazide or thiazide-like diuretic such as hydrochlorothiazide or chlorthalidone 4, 6, 7, 8
  • An angiotensin-converting enzyme inhibitor or angiotensin receptor blocker such as enalapril or candesartan 4, 6, 7, 8
  • A calcium channel blocker such as amlodipine 4, 6, 7
• Combination therapy with an angiotensin-converting enzyme inhibitor and a calcium channel blocker is also effective 7
• The combination of ACE inhibitors with thiazides is safe and well-tolerated, and should be considered among the first-line treatments in most patients with hypertension 8

Blood Pressure Targets

• The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk 4
• Blood pressure targets:
  • SBP/DBP target <130/80 mm Hg for adults <65 years 4
  • SBP <130 mm Hg in adults ≥65 years 4
  • SBP/DBP target <140/90 mm Hg in patients with chronic kidney disease and in those with diabetes mellitus 6