How to manage hypertension (elevated Blood Pressure)?

From the Guidelines

Managing elevated blood pressure requires a multifaceted approach that prioritizes lifestyle interventions, including a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern, weight loss, moderation of alcohol intake, and increased physical activity, as outlined in the 2022 standards of medical care in diabetes 1. To effectively manage elevated blood pressure, the following key lifestyle changes should be implemented:

• Adopting a DASH-style diet that is low in sodium (<2,300 mg/day) and rich in fruits, vegetables, whole grains, and lean proteins
• Restricting sodium intake and increasing potassium consumption
• Moderating alcohol intake to no more than 2 servings per day for men and no more than 1 serving per day for women
• Engaging in regular physical activity, such as 150 minutes of moderate exercise per week
• Achieving and maintaining a healthy weight through caloric restriction and increased activity levels These lifestyle interventions are essential for lowering blood pressure, enhancing the effectiveness of antihypertensive medications, and promoting overall metabolic and vascular health, as emphasized in the 2022 guidelines 1. In addition to lifestyle changes, pharmacologic therapy may be necessary for individuals with confirmed office-based blood pressure higher than 140/90 mmHg, with a focus on prompt initiation and timely titration of medication to achieve blood pressure goals 1. The primary goal of managing elevated blood pressure is to reduce the risk of cardiovascular disease and improve quality of life, which can be achieved through a combination of lifestyle interventions and, when necessary, evidence-based pharmacologic therapy, as recommended in the most recent guidelines 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 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)

To manage elevated blood pressure, comprehensive cardiovascular risk management is necessary, including:

• Lipid control
• Diabetes management
• Antithrombotic therapy
• Smoking cessation
• Exercise
• Limited sodium intake It is also important to note that many patients will require more than one drug to achieve blood pressure goals. For specific advice, 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

Managing Elevated Blood Pressure

To manage elevated blood pressure, several lifestyle modifications can be implemented. These include:

• Increasing physical activity, as recommended by the American Heart Association 4
• Maintaining a healthy dietary pattern, such as reducing sodium intake and increasing fruit and vegetable consumption 5, 6
• Managing body weight and reducing obesity 5, 7
• Limiting alcohol consumption and avoiding excessive drinking 7, 8
• Quitting smoking and avoiding secondhand smoke 7
• Reducing stress and promoting adequate sleep patterns 5

Benefits of Lifestyle Interventions

Lifestyle interventions have been shown to have numerous benefits for managing elevated blood pressure, including:

• Reducing systolic blood pressure by 3.5 mm Hg and decreasing the risk of cardiovascular disease by 30% 7
• Improving vascular health and reducing sympathetic overactivation 5
• Increasing secretion of myokines and improving redox and inflammatory status 5
• Reducing dietary sodium intake and improving overall dietary quality 6

Barriers to Lifestyle Modification

Despite the benefits of lifestyle interventions, several barriers exist, including:

• Limited access to healthcare and health insurance 8
• Physical impairment or disability 8
• Lack of health education and counseling 7, 8
• Difficulty in making sustained lifestyle changes 8