What are the implications of Stage I hypertension (elevated blood pressure)?

From the Guidelines

For patients with stage I hypertension, nonpharmacological therapy is the preferred initial treatment, particularly for those with an estimated 10-year ASCVD risk of <10%, and should be assessed for adherence and impact within 3 to 6 months. This approach is supported by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.

Key Components of Nonpharmacological Therapy

• Weight loss if overweight
• Adoption of the DASH diet, which is rich in fruits, vegetables, and low-fat dairy with reduced saturated fat
• Reduction of sodium intake to less than 2,300 mg per day
• Increase in physical activity to at least 150 minutes of moderate-intensity exercise per week
• Limitation of alcohol consumption

For patients with stage I hypertension and an estimated 10-year ASCVD risk of ≥10%, nonpharmacological therapy should be used in addition to pharmacological therapy as first-line therapy 1. The decision to initiate medication therapy should consider the patient's overall cardiovascular risk profile, and medications such as thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers may be appropriate.

Monitoring and Adjustment

Regular blood pressure monitoring is crucial to assess the effectiveness of the chosen therapy and to make necessary adjustments. The goal of treatment is to bring blood pressure readings below 130/80 mmHg, which requires long-term management and adherence to the recommended lifestyle modifications and, if necessary, medication regimen. This approach is aimed at reducing the risk of cardiovascular disease, stroke, and kidney damage associated with uncontrolled hypertension.

From the Research

Definition and Management of Stage I Hypertension

• Stage I hypertension is a condition where blood pressure is elevated, but not to the extent of stage II hypertension 2.
• Management of stage I hypertension may involve non-pharmacological interventions, such as lifestyle modifications, including dietary changes, exercise, stress reduction, and minimizing alcohol consumption 2.

Dietary Modifications for Stage I Hypertension

• The DASH diet, which emphasizes fruits, vegetables, whole grains, and low-fat dairy products, has been shown to be effective in lowering blood pressure 3.
• Restricting sodium intake is also crucial in managing stage I hypertension, with studies suggesting that reducing sodium intake can have a significant impact on blood pressure reduction 3.
• The DASH diet, combined with sodium restriction, may be an effective approach to managing stage I hypertension, with some studies suggesting that this combination can lower blood pressure to an extent not previously demonstrated with non-pharmacologic treatment 3.

Pharmacological Interventions for Stage I Hypertension

• While non-pharmacological interventions are often recommended as the first line of treatment for stage I hypertension, pharmacological interventions may be necessary in some cases 4.
• Studies have compared the effectiveness of different antihypertensive medications, including diuretics, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors, in managing hypertension 4, 5.
• ACE inhibitors, in particular, have been shown to be effective in managing hypertension, although they may have side effects and interact with other medications 5.

Interaction between Diet and Renin-Angiotensin-Aldosterone System (RAAS)

• The DASH diet has been shown to interact with the RAAS, resulting in vascular and hormonal responses that may augment the hypotensive effect of ACE inhibition 6.
• Studies have suggested that the DASH diet may increase plasma renin activity and aldosterone sensitivity to angiotensin II infusion, which may contribute to its blood pressure-lowering effects 6.