From the Guidelines
The recommended approach to diagnose and manage hypertension begins with accurate blood pressure measurement, using a properly calibrated device after the patient has been seated quietly for 5 minutes, with readings taken on at least two separate occasions, as stated in the 2022 World Health Organization guideline executive summary 1. Hypertension is diagnosed when systolic blood pressure is ≥130 mmHg or diastolic blood pressure is ≥80 mmHg.
Diagnosis and Evaluation
- Accurate blood pressure measurement is crucial for diagnosis, using a properly calibrated device after the patient has been seated quietly for 5 minutes, with readings taken on at least two separate occasions.
- Hypertension is diagnosed when systolic blood pressure is ≥130 mmHg or diastolic blood pressure is ≥80 mmHg.
- Evaluation should include assessment of overall cardiovascular risk, including factors such as age, sex, smoking status, diabetes, and lipid profiles.
Lifestyle Modifications
- Initial management should include lifestyle modifications for all patients, including:
- Weight reduction, if indicated
- Adopting the DASH diet (rich in fruits, vegetables, and low-fat dairy products)
- Sodium restriction to <2.3g daily
- Regular physical activity (150 minutes of moderate-intensity exercise weekly)
- Limiting alcohol consumption, as recommended by the 2022 standards of medical care in diabetes 1
Pharmacological Treatment
- For pharmacological treatment, first-line medications include:
- Thiazide diuretics (hydrochlorothiazide 12.5-25mg daily)
- ACE inhibitors (lisinopril 10-40mg daily)
- ARBs (losartan 50-100mg daily)
- Calcium channel blockers (amlodipine 5-10mg daily), as recommended by the 2022 World Health Organization guideline executive summary 1
- Treatment should be initiated with a single agent at a low dose, then titrated upward if blood pressure goals aren't met.
- For stage 2 hypertension (≥140/90 mmHg), consider starting with two agents from different classes.
Monitoring and Follow-up
- Blood pressure targets are generally <130/80 mmHg, though this may be individualized based on comorbidities and age.
- Regular monitoring is essential, with follow-up every 3-6 months once blood pressure is controlled, as stated in the 2018 American College of Cardiology/American Heart Association hypertension guideline 1.
- This approach is effective because it addresses both the physiological mechanisms of hypertension and modifiable risk factors, reducing cardiovascular risk and preventing end-organ damage.
From the FDA Drug Label
INDICATIONS & USAGE 1. 1 Hypertension Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. 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)
The recommended approach to diagnose and manage hypertension involves:
- Comprehensive cardiovascular risk management: including lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake
- Blood pressure reduction: to lower the risk of fatal and non-fatal cardiovascular events
- Multiple drug therapy: many patients will require more than one drug to achieve blood pressure goals
- Following 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 However, the FDA drug label does not provide a step-by-step guide on how to diagnose hypertension. For the evaluation and treatment, the following steps can be considered:
- Evaluation: assess the patient's blood pressure and cardiovascular risk factors
- Treatment: initiate therapy with a single drug or multiple drugs, as needed, to achieve blood pressure goals
- Monitoring: regularly monitor the patient's blood pressure and adjust treatment as needed It is essential 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), for specific advice on goals and management 2.
From the Research
Diagnosis 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 3
- Diagnosis is typically made through measurement of blood pressure using a sphygmomanometer
Evaluation of Hypertension
- Evaluation involves assessing the level of blood pressure and the presence of high atherosclerotic cardiovascular disease (CVD) risk 3
- Patients with hypertension should be evaluated for target organ damage, such as heart failure, coronary heart disease, and stroke
- Laboratory tests, such as blood chemistry and urinalysis, may be ordered to assess for underlying conditions that may be contributing to hypertension
Treatment of Hypertension
- First-line therapy for hypertension is lifestyle modification, including:
- Pharmacologic therapy may be initiated if lifestyle modifications are not effective in lowering blood pressure
- First-line drug therapy for hypertension consists of:
- Combination therapy may be used if monotherapy is not effective in achieving blood pressure goals 5, 6
- Treatment goals include achieving a blood pressure of less than 130/80 mm Hg for adults under 65 years and a systolic blood pressure of less than 130 mm Hg for adults 65 years and older 3
Management of Hypertension
- Management involves regular monitoring of blood pressure and adjustment of therapy as needed
- Patients with hypertension should be educated on lifestyle modifications and the importance of adherence to pharmacologic therapy
- Regular follow-up appointments with a healthcare provider are necessary to monitor blood pressure and adjust therapy as needed
- Patients with chronic kidney disease, diabetes, or heart failure may require more intensive management and monitoring 5, 7