What is the recommended treatment for a 46-year-old patient with elevated blood pressure (hypertension)?

From the Guidelines

For a 46-year-old patient with a blood pressure of 133/95, lifestyle modifications should be initiated first, and antihypertensive medication should be considered if the blood pressure remains above 140/90 mmHg despite these measures, with a target blood pressure of less than 130/80 mmHg. According to the American College of Cardiology/American Heart Association hypertension guideline 1, the recommended treatment approach involves lifestyle changes, including adopting the DASH diet, reducing sodium intake to less than 2,300 mg daily, regular physical activity, limiting alcohol consumption, maintaining a healthy weight, and smoking cessation. If lifestyle modifications are insufficient to control blood pressure, medication therapy should be initiated, with first-line medications including thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers, or calcium channel blockers. The choice of antihypertensive drug therapy depends on the patient's comorbidities, with ACE inhibitors or ARBs preferred for those with diabetes or kidney disease, as stated in the 2017 American College of Cardiology/American Heart Association hypertension guideline 1. Key lifestyle modifications, as outlined in the standards of medical care in diabetes-2018 1, include:

• Weight loss if overweight or obese
• A Dietary Approaches to Stop Hypertension–style dietary pattern
• Moderation of alcohol intake
• Increased physical activity Regular monitoring of blood pressure is crucial, and medication adherence is essential to prevent complications like heart disease, stroke, and kidney damage. The patient's blood pressure should be monitored regularly to ensure that the target blood pressure of less than 130/80 mmHg is achieved, as recommended by the 2017 American College of Cardiology/American Heart Association hypertension guideline 1.

From the FDA Drug Label

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From the Research

Treatment Recommendations for Hypertension

According to the provided studies, the treatment for a 46-year-old patient with elevated blood pressure (hypertension) involves lifestyle modifications and, if necessary, antihypertensive medication.

• The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease (CVD) risk 2.
• First-line therapy for hypertension is lifestyle modification, including weight loss, a healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 2, 3, 4.
• The blood pressure-lowering effects of individual lifestyle components are partially additive and enhance the efficacy of pharmacologic therapy 2.
• When drug therapy is required, first-line therapies are thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and calcium channel blockers 2, 5.

Consideration for Antihypertensive Medication

For a 46-year-old patient with a blood pressure of 133/95 mmHg, consideration for antihypertensive medication should be based on the presence of high atherosclerotic CVD risk and the level of blood pressure.

• The target blood pressure for adults under 65 years is less than 130/80 mmHg 2.
• Lifestyle interventions can lower the calculated CVD risk and dramatically decrease the number of individuals for whom guideline-directed antihypertensive medication is indicated 6.
• The 2017 ACC-AHA Hypertension Guideline recommends initiation of antihypertensive drug therapy based on blood pressure and an assessment of global cardiovascular disease risk 6.

Lifestyle Modifications

Lifestyle modifications are essential in the treatment of hypertension and can help reduce the need for antihypertensive medication.

• Maintaining healthy lifestyle factors, such as a healthy body mass index, diet, smoking cessation, limited alcohol consumption, and regular physical activity, can lower systolic blood pressure and reduce the risk of cardiovascular disease 3.
• A healthy dietary pattern, including low sodium and high potassium intake, can help lower blood pressure 2, 4.