How do I manage hypertension?

From the Guidelines

Managing hypertension effectively requires a multifaceted approach that includes lifestyle interventions as the first line of treatment, with medication added as necessary, based on the most recent guidelines from 2023 1. To manage hypertension, several key lifestyle changes are recommended:

• Adopting a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern, which includes reducing sodium intake to less than 2,300 mg/day and increasing potassium intake through consumption of fruits, vegetables, and low-fat dairy products 1.
• Achieving and maintaining a healthy weight through caloric restriction if indicated, as excess body weight is a significant risk factor for hypertension 1.
• Engaging in regular physical activity, aiming for at least 150 minutes of moderate-intensity aerobic exercise per week, which can help lower blood pressure and improve overall cardiovascular health 1.
• Limiting alcohol consumption to no more than 2 servings per day for men and no more than 1 serving per day for women, as excessive alcohol intake can elevate blood pressure 1.
• Increasing activity levels and considering the use of internet or mobile-based digital platforms to reinforce healthy behaviors, which have been shown to enhance the efficacy of medical therapy for hypertension 1.

These lifestyle interventions are not only beneficial for lowering blood pressure but also for enhancing the effectiveness of antihypertensive medications, promoting metabolic and vascular health, and reducing the risk of cardiovascular disease with minimal adverse effects 1. The most effective strategy for managing hypertension is to combine these lifestyle modifications with pharmacologic therapy when hypertension is diagnosed, as outlined in the 2023 standards of care for diabetes and cardiovascular disease management 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)

To manage hypertension, comprehensive cardiovascular risk management is necessary, which includes:

• Lipid control
• Diabetes management
• Antithrombotic therapy
• Smoking cessation
• Exercise
• Limited sodium intake It is also important to note that many patients will require more than one drug to achieve their blood pressure goals. For specific guidance, it is recommended to consult published guidelines, such as those from the National High Blood Pressure Education Program’s Joint National Committee 2 3.

From the Research

Managing Hypertension

To manage hypertension, several lifestyle modifications and interventions can be implemented. These include:

• Maintaining a healthy body mass index (BMI) to reduce systolic blood pressure by 3.5 mm Hg and lower the risk of cardiovascular disease (CVD) by about 30% 4
• Following a diet that emphasizes vegetables, fruits, and whole grains, and limiting sodium intake to less than 2,400 mg per day 5
• Exercising regularly, with recommendations of three or four times per week for an average of 40 minutes per session 5
• Reducing alcohol consumption, with limitations of 2 or fewer standard drinks per day (maximum of 14/week for men and 9/week for women) 6
• Quitting tobacco and avoiding smoking 5
• Managing stress through individualized cognitive behavior modification 6
• Getting adequate sleep and maintaining a healthy circadian rhythm 7

Nonpharmacologic Strategies

Nonpharmacologic strategies for managing hypertension include:

• Weight loss for overweight patients 8, 6
• Regular exercise and physical activity 5, 7
• Biofeedback and self-measured blood pressure monitoring 5
• Dietary modifications, such as the Dietary Approaches to Stop Hypertension (DASH) diet 8
• Restricting sodium intake and managing stress levels 6

Lifestyle Interventions

Lifestyle interventions can be effective in preventing and treating hypertension. These interventions include:

• Regular physical exercise to improve vascular health and reduce sympathetic overactivation 7
• Body weight management to prevent obesity and insulin resistance 7
• Healthy dietary patterns, such as the DASH diet, to improve redox and inflammatory status 7
• Stress management and promotion of adequate sleep patterns to reduce non-traditional mechanisms such as increased secretion of myokines 7