How to manage diastolic hypertension?

From the Guidelines

Managing diastolic hypertension requires a comprehensive approach combining lifestyle modifications and medication, with a treatment goal of achieving a diastolic blood pressure below 80 mmHg, as recommended by the American Heart Association and the American Diabetes Association 1. To manage diastolic hypertension, the following steps can be taken:

• Adopting lifestyle modifications such as weight control, increased physical activity, alcohol moderation, sodium reduction, and emphasis on increased consumption of fresh fruits, vegetables, and low-fat dairy products for a maximum of 3 months before initiating pharmacological agents, if targets are not achieved 1.
• Initiating medication with first-line options including ACE inhibitors or ARBs, with other drug classes such as beta-blockers, thiazide diuretics, and calcium channel blockers added as needed to achieve blood pressure targets 1.
• Monitoring renal function and serum potassium levels within the first 3 months of using ACE inhibitors, ARBs, or diuretics, and following up every 6 months thereafter if levels are stable 1.
• Lowering blood pressure gradually in elderly hypertensive patients to avoid complications, and performing orthostatic measurement of blood pressure when clinically indicated 1.
• Referring patients who do not achieve target blood pressure despite multiple-drug therapy to a physician specializing in the care of patients with hypertension 1. Key considerations in managing diastolic hypertension include:
• Regular blood pressure monitoring, either at home or through follow-up appointments every 2-4 weeks until blood pressure is controlled.
• The potential complications of diastolic hypertension, including heart disease, stroke, and kidney damage, which can be mitigated by achieving and maintaining a diastolic blood pressure below 80 mmHg 1.

From the FDA Drug Label

Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit 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 diastolic hypertension, it is essential to:

• Reduce blood pressure through medication, such as lisinopril 2 or amlodipine 3
• Implement comprehensive cardiovascular risk management, including:
  • Lipid control
  • Diabetes management
  • Antithrombotic therapy
  • Smoking cessation
  • Exercise
  • Limited sodium intake
• 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.

From the Research

Managing Diastolic Hypertension

To manage diastolic hypertension, several approaches can be taken, including:

• Lifestyle modifications, such as weight loss, healthy dietary patterns, physical activity, and moderation or elimination of alcohol consumption 4, 5, 6, 7
• Reducing sodium intake and increasing potassium intake 4, 5, 6
• Following a diet enriched in fruits, vegetables, and low-fat dairy products, such as the Dietary Approaches to Stop Hypertension (DASH) diet 6
• Engaging in regular physical exercise and managing body weight 7
• Practicing stress management and promoting adequate sleep patterns coupled with circadian entrainment 7

Medication Therapy

When lifestyle modifications are not sufficient to control diastolic hypertension, medication therapy may be necessary. 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:

• Thiazide or thiazide-like diuretics, such as hydrochlorothiazide or chlorthalidone 4, 5
• Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, such as enalapril or candesartan 4, 5
• Calcium channel blockers, such as amlodipine 4, 5

Blood Pressure Targets

The goal of treatment for diastolic hypertension is to achieve a blood pressure target of less than 130/80 mmHg for adults under 65 years and a systolic blood pressure target of less than 130 mmHg for adults 65 years and older 4. However, the evidence for these targets is not universally accepted, and some studies suggest that lowering systolic blood pressure below 140 mmHg may be beneficial for certain patient populations 8.