What are the guidelines for managing Hypertension (High Blood Pressure)?

From the Guidelines

Hypertension should be managed according to the most recent guidelines, which recommend a blood pressure threshold of ≥130/80 mmHg for diagnosis and ≥140/90 mmHg for pharmacological treatment initiation, with a goal of <130/80 mmHg for most patients. The management of hypertension involves a combination of lifestyle modifications and pharmacological treatment. Lifestyle modifications are the foundation of treatment and include reducing sodium intake, increasing physical activity, maintaining a healthy weight, limiting alcohol consumption, and following a heart-healthy diet 1.

Initial Evaluation and Treatment

Initial evaluation should include assessing cardiovascular risk factors, screening for secondary causes, and checking for target organ damage. Pharmacological treatment is recommended for patients with blood pressure ≥140/90 mmHg or those at high cardiovascular risk with blood pressure ≥130/80 mmHg. First-line medications include thiazide diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs) 1.

Medication Regimens

Common initial regimens include:

• Lisinopril 10 mg daily (ACE inhibitor)
• Amlodipine 5 mg daily (CCB)
• Hydrochlorothiazide 12.5 mg daily (thiazide diuretic) Adjust medications every 2-4 weeks until target blood pressure is achieved. The goal is <130/80 mmHg for most patients, but individualize targets based on age, comorbidities, and tolerability. Monitor kidney function and electrolytes, especially when using ACE inhibitors or ARBs 1.

Follow-up and Monitoring

Regular follow-up is crucial. Schedule visits every 3-6 months for stable patients and more frequently for those with uncontrolled hypertension or medication adjustments. Encourage home blood pressure monitoring to guide treatment decisions. This approach aims to reduce cardiovascular risk by controlling blood pressure through a combination of lifestyle changes and appropriate medication use, as recommended by the World Health Organization 1 and the American College of Cardiology/American Heart Association 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 one 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 guidelines for managing Hypertension (High Blood Pressure) include:

• Comprehensive cardiovascular risk management
• Lipid control
• Diabetes management
• Antithrombotic therapy
• Smoking cessation
• Exercise
• Limited sodium intake
• Following published guidelines, such as those of the National High Blood Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) 2 3

From the Research

Guidelines for Managing Hypertension

The guidelines for managing hypertension involve a combination of lifestyle modifications and pharmacologic therapy.

• Lifestyle modification is the first-line therapy for hypertension, including:
  • Weight loss
  • Healthy dietary pattern with low sodium and high potassium intake
  • Physical activity
  • Moderation or elimination of alcohol consumption 4, 5, 6, 7
• The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk 4
• First-line drug therapy for hypertension consists of:
  • A thiazide or thiazide-like diuretic
  • An angiotensin-converting enzyme inhibitor or angiotensin receptor blocker
  • A calcium channel blocker and should be titrated according to office and home blood pressure levels to achieve a target blood pressure of <130/80 mm Hg for adults <65 years and systolic blood pressure <130 mm Hg in adults ≥65 years 4

Lifestyle Modifications

Lifestyle modifications are essential for managing hypertension, and the benefits are worth the effort.

• Weight loss and exercise, along with moderation of alcohol use and cessation of smoking, are crucial 7
• Consuming fresh rather than processed foods and limiting the use of salt in cooking and at the table are also recommended 7
• Lifestyle modifications can reduce blood pressure and improve biomarkers of cardiovascular risk in patients with resistant hypertension 8

Resistant Hypertension

Resistant hypertension is a condition where patients fail to achieve the recommended blood pressure treatment targets on 3 antihypertensive medications or require ≥4 medications to achieve goal.

• Lifestyle modifications, such as aerobic exercise, weight loss, and dietary modification, can reduce clinic and ambulatory blood pressure in patients with resistant hypertension 8
• Multi-component trials involving exercise and dietary modification and weight management can facilitate lifestyle change, reduce blood pressure, and improve biomarkers of cardiovascular risk in patients with resistant hypertension 8