From the Guidelines
For a patient with a blood pressure reading of 130/90 mmHg, the initial management should focus on lifestyle modifications for a maximum of 3 months before considering medication, as recommended by the American Heart Association and the American Diabetes Association 1. The lifestyle modifications include:
- Adopting a healthy diet, such as the DASH diet, rich in fruits, vegetables, whole grains, and low-fat dairy products
- Reducing sodium intake to less than 2,300 mg per day
- Regular physical activity, at least 150 minutes of moderate-intensity exercise per week
- Limiting alcohol consumption
- Maintaining a healthy weight
- Smoking cessation If the patient has additional cardiovascular risk factors, diabetes, or chronic kidney disease, pharmacological therapy may be initiated immediately alongside lifestyle changes, with first-line medication options including:
- Thiazide diuretics, such as chlorthalidine 12.5-25 mg daily or hydrochlorothiazide 12.5-25 mg daily
- ACE inhibitors, like lisinopril 10-40 mg daily
- ARBs, such as losartan 50-100 mg daily
- Calcium channel blockers, such as amlodipine 5-10 mg daily The choice of medication should be individualized based on comorbidities, potential side effects, and patient preferences, as suggested by the standards of medical care in diabetes 1. Regular blood pressure monitoring is essential, with a target of less than 130/80 mmHg, and multiple-drug therapy may be required to achieve blood pressure targets, as stated in the primary prevention of cardiovascular diseases in people with diabetes mellitus 1. Key considerations in managing hypertension include:
- Monitoring renal function and serum potassium levels if ACE inhibitors, ARBs, or diuretics are used
- Gradually lowering blood pressure in elderly hypertensive patients to avoid complications
- Referring patients who do not achieve target blood pressure despite multiple-drug therapy to a physician specializing in the care of patients with hypertension, as recommended by the American Heart Association and the American Diabetes 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 management plan for a patient with a blood pressure reading of 130/90 mmHg, indicating stage 1 hypertension, should include:
- Comprehensive cardiovascular risk management
- Lifestyle modifications such as exercise and limited sodium intake
- Monitoring and potential adjustment of medication as needed to achieve blood pressure goals, which may require more than one drug 2, 3. Medications such as lisinopril or amlodipine may be used alone or in combination with other antihypertensive agents to lower blood pressure.
From the Research
Management Plan for Stage 1 Hypertension
A patient with a blood pressure reading of 130/90 mmHg is considered to have stage 1 hypertension. The management plan for such a patient involves lifestyle modifications and possibly medication.
Lifestyle Modifications
- Weight loss, if the patient is overweight or obese
- Regular physical activity, such as walking or other aerobic exercises
- Healthy diet, low in sodium and rich in fruits, vegetables, and whole grains
- Limiting alcohol consumption
- Quitting smoking, if applicable
Medication
- According to a study published in 2021 4, calcium channel blockers, beta blockers, and angiotensin receptor blockers are effective in reducing blood pressure in patients with hypertension.
- Another study published in 2019 5 suggests that a fixed combination of an ACE inhibitor and a calcium channel blocker is a first-choice therapy for hypertension.
- A review of 23 randomized controlled trials published in 2022 6 found that calcium channel blockers are effective in reducing blood pressure and preventing cardiovascular events, but may increase the risk of congestive heart failure compared to other antihypertensive classes.
Combination Therapy
- A study published in 2013 7 found that combining a renin-angiotensin-aldosterone system inhibitor with a calcium channel blocker or a diuretic is effective in reducing blood pressure and preventing cardiovascular events.
- Another study published in 2007 8 found that dual therapy with a calcium channel blocker and a beta blocker or an ACE inhibitor is effective in achieving blood pressure control and reducing cardiovascular risk in patients with hypertension and coronary artery disease.