From the Guidelines
Hypertension management should prioritize a blood pressure target of less than 130/80 mmHg, with lifestyle modifications as first-line treatment and medication added as necessary, according to the most recent World Health Organization guidelines 1.
Key Recommendations
- Lifestyle modifications, including reducing sodium intake to less than 2,300 mg daily, following the DASH diet, regular physical activity, limiting alcohol consumption, and maintaining a healthy weight, are recommended for all patients with hypertension 1.
- For stage 1 hypertension (130-139/80-89 mmHg) without cardiovascular disease or risk factors, lifestyle changes alone may be sufficient, while for stage 2 hypertension (≥140/90 mmHg) or stage 1 with high cardiovascular risk, medication is typically recommended alongside lifestyle changes 1.
- First-line medications include thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers, with many patients requiring two or more medications to reach target blood pressure goals 1.
Considerations for Special Populations
- For older adults (65+ years), a target of less than 130/80 mmHg is still recommended if tolerated, but treatment should be carefully monitored to avoid side effects like orthostatic hypotension 1.
- The guidelines prioritize simplicity and protocolized care, especially in low-resource settings, to facilitate standard approaches to pharmacological treatment and management of hypertension 1.
Monitoring and Adjustment
- Regular blood pressure monitoring is essential, either through home measurements or clinical visits, to ensure treatment effectiveness and make necessary adjustments 1.
- The goal of the guideline is to facilitate uptake of a standard approach to the pharmacological treatment and management of hypertension, which will increase the hypertension control rate worldwide 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 current guidelines on hypertension recommend comprehensive cardiovascular risk management, including:
- Lipid control
- Diabetes management
- Antithrombotic therapy
- Smoking cessation
- Exercise
- Limited sodium intake For specific advice on goals and management, it is recommended to consult 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
Current Guidelines on Hypertension
The current guidelines on hypertension recommend lifestyle modification as the first-line therapy, including:
- Weight loss
- Healthy dietary pattern with low sodium and high potassium intake
- Physical activity
- Moderation or elimination of alcohol consumption 4, 5, 6 These lifestyle modifications have been shown to be effective in reducing blood pressure and decreasing the risk of cardiovascular disease (CVD) events 7, 8.
Blood Pressure Targets
The recommended blood pressure targets are:
- Less than 130/80 mm Hg for adults under 65 years
- Less than 130 mm Hg for adults 65 years and older 4
- Less than 140/90 mm Hg for patients with chronic kidney disease and diabetes mellitus 5
Pharmacologic Therapy
First-line drug therapy for hypertension consists of:
- Thiazide or thiazide-like diuretics
- Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers
- Calcium channel blockers 4, 5 These medications should be titrated according to office and home blood pressure levels to achieve the recommended targets.
Lifestyle Interventions
Lifestyle interventions, such as the Dietary Approaches to Stop Hypertension (DASH) diet and behavioral weight management, have been shown to be effective in reducing blood pressure and decreasing the need for antihypertensive medication 7, 8. These interventions can lower the calculated CVD risk and dramatically decrease the number of individuals for whom guideline-directed antihypertensive medication is indicated 8.