From the Guidelines
The management plan for a patient with borderline blood pressure should begin with lifestyle modifications, including weight loss, a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern, moderation of alcohol intake, and increased physical activity, as recommended by the most recent guidelines 1. The goal of these modifications is to lower blood pressure, enhance the effectiveness of antihypertensive medications, and promote overall metabolic and vascular health.
- Key lifestyle interventions include:
- Weight loss through caloric restriction
- Adoption of a DASH-style eating pattern, which is rich in fruits, vegetables, and low-fat dairy products
- Restricting sodium intake to less than 2,300 mg/day
- Increasing consumption of fruits and vegetables (8–10 servings per day) and low-fat dairy products (2–3 servings per day)
- Avoiding excessive alcohol consumption (no more than 2 servings per day in men and no more than 1 serving per day in women)
- Increasing physical activity levels, with at least 150 minutes of moderate-intensity aerobic activity per week These lifestyle modifications are reasonable for individuals with mildly elevated blood pressure (systolic >120 mmHg or diastolic >80 mmHg) and should be initiated as part of the management plan, as supported by recent guidelines 1. Lifestyle therapy should be developed in collaboration with the patient and discussed as part of overall health management, with consideration of using internet or mobile-based digital platforms to reinforce healthy behaviors 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)
The management plan for a patient with borderline blood pressure (hypertension) should include comprehensive cardiovascular risk management. This may involve:
- Lipid control
- Diabetes management
- Antithrombotic therapy
- Smoking cessation
- Exercise
- Limited sodium intake It is also recommended to follow 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 3.
From the Research
Management Plan for Borderline Blood Pressure
The management plan for a patient with borderline blood pressure (hypertension) involves lifestyle modifications and, if necessary, pharmacologic treatment.
- Lifestyle modifications are beneficial for both nonhypertensive and hypertensive persons, and can have powerful effects on blood pressure 4.
- Increased physical activity, reduced salt intake, weight loss, moderation of alcohol intake, increased potassium intake, and an overall healthy dietary pattern can effectively lower blood pressure 4, 5.
- The Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, and low-fat dairy products, is reduced in fat and cholesterol, and can help lower blood pressure 4, 6.
Lifestyle Interventions
Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, can prevent and treat hypertension 5.
- These interventions can also reduce the need for guideline-directed antihypertensive medication 6.
- Stress management and promotion of adequate sleep patterns coupled with circadian entrainment may also be beneficial 5.
Pharmacologic Treatment
If lifestyle modifications are not sufficient to control blood pressure, pharmacologic treatment may be necessary.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are commonly used to treat hypertension, but ACE inhibitors are associated with a higher risk of adverse events, such as cough and angioedema 7.
- The choice of pharmacologic treatment should be based on individual patient characteristics and medical history.
Patient Education and Adherence
Patient education and adherence to lifestyle modifications and pharmacologic treatment are crucial for effective management of borderline blood pressure.
- Patients who receive advice on lifestyle modifications are more likely to adopt these changes, such as changing eating habits, reducing salt intake, exercising, and decreasing alcohol consumption 8.