What is the diagnosis and treatment for Hypertension (High Blood Pressure)?

From the Guidelines

Hypertension should be managed with a combination of lifestyle modifications and medication, with a target blood pressure of below 130/80 mmHg, as recommended by the 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline 1. The management of hypertension involves a multifaceted approach, including lifestyle changes and pharmacological therapy. Lifestyle modifications include adopting a heart-healthy diet low in sodium (less than 2,300 mg daily), regular physical activity (at least 150 minutes of moderate exercise weekly), weight management, limiting alcohol consumption, and avoiding tobacco. Some key points to consider in the management of hypertension include:

• The importance of routine screening to diagnose hypertension, especially in younger patients and African American persons, who may be at higher risk of developing complications 1.
• The use of home blood pressure self-monitoring and 24-h ambulatory blood pressure monitoring to provide additional evidence of "white coat" and masked hypertension 1.
• The benefits of hypertension treatment in reducing the risk of cardiovascular disease, stroke, and kidney problems, as demonstrated by numerous studies 1. The first-line treatment for hypertension typically includes medications such as thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers, with the goal of achieving a blood pressure below 130/80 mmHg 1. Regular monitoring and timely titration of pharmacological therapy are essential to achieve optimal blood pressure control and reduce the risk of complications associated with hypertension.

From the FDA Drug Label

Aliskiren tablets are indicated for the treatment of hypertension in adults and in pediatric patients weighing 50 kg or greater who are at least 6 years of age and older to lower blood pressure. Losartan is indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older, to lower blood pressure.

Hypertension Treatment:

• Aliskiren and losartan are both indicated for the treatment of hypertension in adults and pediatric patients.
• The goal of treatment is to lower blood pressure, which reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.
• Both drugs are part of comprehensive cardiovascular risk management, including 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 2, 3.

From the Research

Definition and Prevalence of Hypertension

• Hypertension is defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg 4
• It affects approximately 116 million adults in the US and more than 1 billion adults worldwide 4

Risk Factors and Complications

• Hypertension is associated with increased risk of cardiovascular disease (CVD) events (coronary heart disease, heart failure, and stroke) and death 4
• An SBP reduction of 10 mm Hg decreases risk of CVD events by approximately 20% to 30% 4

Treatment and Management

• First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 4, 5, 6, 7, 8
• The BP-lowering effects of individual lifestyle components are partially additive and enhance the efficacy of pharmacologic therapy 4
• First-line drug therapy for hypertension consists of a thiazide or thiazidelike diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 4

Lifestyle Interventions

• Applying lifestyle intervention in the form of a continuous care model (CCM) may be recommended to reduce dietary sodium intake and mean systolic and diastolic BP in patients who are hypertensive 5
• Increasing physical activity has extensive benefits, including improving both blood pressure and blood cholesterol, that are comparable, superior, or complementary to other healthy lifestyle changes 6
• Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, can help prevent and treat hypertension 7

Role of Healthcare Professionals

• Pharmacists are in an ideal setting to care for patients with hypertension by managing their medications and lifestyle behaviors 8
• Clinicians can assess, prescribe, counsel, and refer to support increased physical activity in their patients 6