What is the management for hypertension as a risk factor for cardiovascular disease?

From the Guidelines

Management of hypertension as a cardiovascular risk factor requires a comprehensive approach combining lifestyle modifications and pharmacological therapy, with a target blood pressure of <130/80 mmHg for most adults, as recommended by the most recent guidelines 1. The goal of hypertension management is to reduce the risk of cardiovascular disease, which is the leading cause of morbidity and mortality worldwide.

• Key components of lifestyle modifications include:
  • Adopting the DASH diet, rich in fruits, vegetables, and low-fat dairy
  • Reducing sodium intake to <2300 mg daily
  • Regular physical activity, such as 150 minutes of moderate-intensity exercise weekly
  • Limiting alcohol consumption
  • Weight management
• First-line medications for hypertension include:
  • Thiazide diuretics, such as hydrochlorothiazide 12.5-25 mg daily
  • ACE inhibitors, such as lisinopril 10-40 mg daily
  • Angiotensin receptor blockers, such as losartan 25-100 mg daily
  • Calcium channel blockers, such as amlodipine 5-10 mg daily
• Treatment should be individualized based on comorbidities, with ACE inhibitors or ARBs preferred in patients with diabetes or chronic kidney disease 1.
• Blood pressure should be monitored regularly, with home measurements encouraged to guide therapy adjustments, and combination therapy is often necessary to achieve targets 1.
• Medication adherence is crucial for effective management, and these interventions reduce the risk of heart attacks, strokes, heart failure, and kidney disease by decreasing vascular resistance, improving endothelial function, and reducing cardiac workload. The most recent guidelines from the World Health Organization 1 emphasize the importance of a comprehensive approach to hypertension management, including lifestyle modifications and pharmacological therapy, to reduce the risk of cardiovascular disease.
• The guidelines recommend a target blood pressure of <130/80 mmHg for most adults, and provide guidance on the selection of first-line medications and the use of combination therapy.
• The guidelines also emphasize the importance of individualizing treatment based on comorbidities, and of monitoring blood pressure regularly to guide therapy adjustments. Overall, the management of hypertension as a cardiovascular risk factor requires a comprehensive and individualized approach, with a focus on lifestyle modifications and pharmacological therapy, to reduce the risk of cardiovascular disease and improve patient outcomes.

From the FDA Drug Label

Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions 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 Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits

The management for hypertension as a risk factor for cardiovascular disease includes:

• Lowering blood pressure to reduce the risk of fatal and non-fatal cardiovascular events
• Comprehensive cardiovascular risk management, including:
  • Lipid control
  • Diabetes management
  • Antithrombotic therapy
  • Smoking cessation
  • Exercise
  • Limited sodium intake
• Using antihypertensive drugs from a variety of pharmacologic classes to achieve blood pressure goals 2 3

From the Research

Management of Hypertension as a Risk Factor for Cardiovascular Disease

• Hypertension is a major modifiable risk factor for cardiovascular disease (CVD) and is associated with an increased risk of CVD morbidity and mortality 4.
• The management of hypertension involves lifestyle changes, such as dietary modifications and increased physical activity, which are effective in lowering blood pressure and preventing hypertension and its CVD sequelae 4.
• Pharmacological therapy is also effective in lowering blood pressure and preventing CVD outcomes in most patients, with first-line antihypertensive medications including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, dihydropyridine calcium-channel blockers, and thiazide diuretics 4, 5.

Pharmacological Treatment Options

• Angiotensin receptor blockers (ARBs) are a rational, effective, and safe anti-hypertensive pharmacological strategy, with a comparable effect to angiotensin-converting enzyme inhibitors (ACEi) in lowering blood pressure levels, but with better pharmacological tolerability 5.
• Beta-blockers, calcium channel blockers, and ARBs have been shown to have similar efficacy in reducing systolic and diastolic blood pressure, with no significant adverse reactions observed in either class of medicines 6.
• The combination of beta-blockers and ACE inhibitors has been shown to be effective in controlling hypertension and reducing cardiovascular risk, with a single-pill combination providing effective blood pressure lowering and improved cardiovascular outcomes 7.

Choice of Antihypertensive Agent

• The choice of antihypertensive agent should be based on individual patient characteristics, such as the presence of compelling indications, and the potential for adverse events 8.
• ARBs may be preferred over ACE inhibitors due to their lower risk of adverse events, such as cough and angioedema, although both classes of agents have similar efficacy in terms of blood pressure lowering and cardiovascular outcomes 8.