What is the management for a hypertensive lady with elevated blood pressure?

From the Guidelines

The management for a hypertensive lady with elevated blood pressure, such as 74/129 mm Hg, should begin with lifestyle modifications and may require pharmacological therapy to achieve a target blood pressure of <130/80 mmHg.

Initial Management

Initial lifestyle changes include:

• Adopting the DASH diet (rich in fruits, vegetables, whole grains, and low-fat dairy) 1
• Reducing sodium intake to less than 2.3g daily
• Regular physical activity (150 minutes of moderate-intensity exercise weekly)
• Weight loss if overweight
• Limiting alcohol consumption
• Smoking cessation If blood pressure remains ≥140/90 mmHg despite lifestyle changes, medication is indicated.

Pharmacological Therapy

First-line agents include:

• Thiazide diuretics (e.g., hydrochlorothiazide 12.5-25mg daily)
• ACE inhibitors (e.g., lisinopril 10-40mg daily)
• ARBs (e.g., losartan 50-100mg daily)
• Calcium channel blockers (e.g., amlodipine 5-10mg daily) 1 For women of childbearing potential, ACE inhibitors and ARBs should be avoided due to teratogenicity.

Monitoring and Adjustment

Blood pressure should be monitored regularly, with a target of <130/80 mmHg for most patients. Combination therapy may be necessary if monotherapy is insufficient. These medications work through different mechanisms: diuretics reduce fluid volume, ACE inhibitors and ARBs block the renin-angiotensin system, and calcium channel blockers relax vascular smooth muscle. Treatment should be individualized based on comorbidities, age, race, and potential side effects.

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 for a hypertensive lady with elevated blood pressure, such as 74/129 mm Hg, involves comprehensive cardiovascular risk management. This includes:

• Lipid control
• Diabetes management
• Antithrombotic therapy
• Smoking cessation
• Exercise
• Limited sodium intake It is also noted that many patients will require more than 1 drug to achieve blood pressure goals. For specific advice on goals and management, it is recommended 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) 2 3.

From the Research

Management of Hypertension

The management of a hypertensive lady with elevated blood pressure, such as 74/129 mm Hg, involves a combination of lifestyle modifications and pharmacologic therapy.

• Lifestyle modifications include:
  • Weight loss
  • Healthy dietary pattern with low sodium and high potassium intake
  • Physical activity
  • Moderation or elimination of alcohol consumption
• Pharmacologic therapy may be initiated based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease (CVD) risk 4.

First-Line Therapy

First-line therapy for hypertension consists of:

• A thiazide or thiazide-like diuretic such as hydrochlorothiazide or chlorthalidone
• An angiotensin-converting enzyme inhibitor or angiotensin receptor blocker such as enalapril or candesartan
• A calcium channel blocker such as amlodipine These medications should be titrated according to office and home systolic blood pressure (SBP)/diastolic blood pressure (DBP) levels to achieve a target of <130/80 mm Hg for adults <65 years and SBP <130 mm Hg in adults ≥65 years 4.

Alternative Therapies

Alternative therapies, such as angiotensin receptor blockers (ARBs), may be considered for patients who are intolerant to angiotensin-converting enzyme (ACE) inhibitors.

• ARBs have been shown to have equal efficacy to ACE inhibitors in reducing blood pressure and cardiovascular outcomes, but with fewer adverse events 5.
• Combination therapy with a calcium channel blocker and an ARB has also been shown to be effective in reducing blood pressure and may be considered for patients with hypertension 6.

Specific Patient Populations

In elderly hypertensive patients with previous ACE inhibitor-induced cough, alternative therapies such as losartan may be considered.

• Losartan has been shown to have a lower incidence of cough compared to ACE inhibitors and may be a suitable alternative for these patients 7.