From the Guidelines
Hypertension management should aim to achieve a target blood pressure below 130/80 mmHg for most adults, with lifestyle modifications and medication therapy as the cornerstone of treatment. The most recent guidelines, such as the 2024 European Society of Cardiology guidelines 1, recommend a target blood pressure of <130/80 mmHg for individuals with known cardiovascular disease or a 10-year risk of cardiovascular disease of ≥10%.
Lifestyle Modifications
Lifestyle changes should include:
- The DASH diet, rich in fruits, vegetables, whole grains, and low-fat dairy
- Sodium restriction to less than 2.3g daily
- Regular physical activity, such as 150 minutes of moderate exercise weekly
- Weight management
- Limiting alcohol consumption
- Smoking cessation
Medication Therapy
First-line medications include:
- Thiazide diuretics, such as hydrochlorothiazide 12.5-25mg daily
- ACE inhibitors, such as lisinopril 10-40mg daily
- ARBs, such as losartan 25-100mg daily
- Calcium channel blockers, such as amlodipine 5-10mg daily Start with a single agent at a low dose and titrate upward every 2-4 weeks until blood pressure goals are achieved. If blood pressure remains uncontrolled on a maximum dose of one medication, add a second agent from a different class. Many patients require two or more medications for adequate control.
Monitoring and Adherence
Regular home blood pressure monitoring is essential, with readings taken at the same time daily, after 5 minutes of rest, with the arm supported at heart level. Medication adherence is crucial for successful management. These approaches work by reducing vascular resistance, blood volume, or cardiac output, thereby lowering blood pressure and reducing the risk of cardiovascular events, stroke, kidney disease, and other complications associated with uncontrolled hypertension, as supported by the World Health Organization guidelines 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 guidelines for managing Hypertension (HTN) include:
- Comprehensive cardiovascular risk management
- Lipid control
- Diabetes management
- Antithrombotic therapy
- Smoking cessation
- Exercise
- Limited sodium intake
- Following 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
Guidelines for Managing Hypertension (HTN)
The management of hypertension involves a combination of lifestyle modifications and pharmacological interventions. The following are some guidelines for managing HTN:
- Lifestyle Modifications: Lifestyle changes are widely advocated as initial and adjuvant therapy for the treatment and prevention of hypertension 4. These modifications include:
- Dietary changes: reducing sodium intake, adopting the Dietary Approaches to Stop Hypertension (DASH) diet, and increasing consumption of fruits, vegetables, and low-fat dairy products 5
- Weight loss: maintaining a healthy body weight or losing weight if overweight 6
- Regular exercise: engaging in physical activity to reduce blood pressure 6
- Alcohol reduction: limiting alcohol consumption to 2 or fewer standard drinks per day 6
- Stress management: using techniques such as cognitive behavior modification to reduce stress 6
- Pharmacological Interventions: Pharmacological agents are available for the initial treatment of high blood pressure, including:
- Thiazide diuretics
- Beta-blocking agents
- Dihydropyridine calcium channel blockers (CCB)
- Angiotensin converting enzyme (ACE) inhibitors
- Angiotensin receptor blockers (ARB) 7
- Comprehensive Hypertension Management: Comprehensive management of hypertension focuses on reducing overall cardiovascular risk by lifestyle measures, blood pressure lowering, and lipid management 7.
- Salt Intake: Reducing dietary sodium to no more than 100 mmol (about 2.4 g sodium or approximately 6 g salt) per day is recommended to prevent blood pressure from rising 8.
- Individualized Therapy: Individualized therapy is recommended for hypertensive patients, emphasizing weight loss, abstinence from or moderation in alcohol intake, regular exercise, restriction of sodium intake, and stress management 6.