From the Guidelines
The treatment recommendations for hypertension include initiating antihypertensive drug therapy if sustained systolic blood pressure ≥ 160 mm Hg or sustained diastolic blood pressure ≥ 100 mm Hg, and lifestyle modifications for all people with high blood pressure, borderline or high normal blood pressure 1.
Key Recommendations
- Initiate antihypertensive drug therapy if sustained systolic blood pressure ≥ 160 mm Hg or sustained diastolic blood pressure ≥ 100 mm Hg 1.
- Consider initiating treatment if cardiovascular disease or other target organ damage present, or if estimated 10 year risk of cardiovascular disease is ≥ 20% 1.
- Optimal goals for blood pressure treatment are: systolic blood pressure < 140 mm Hg and diastolic blood pressure < 85 mm Hg for non-diabetic people, and systolic blood pressure < 130 mm Hg and diastolic blood pressure < 80 mm Hg for people with diabetes mellitus, chronic renal disease, or established cardiovascular disease 1.
- Most people with high blood pressure will require at least two blood pressure lowering drugs to achieve the recommended goals, and fixed drug combinations are recommended when no disadvantages of cost exist 1.
Lifestyle Modifications
- All people with high blood pressure, borderline or high normal blood pressure should be advised on lifestyle modifications, including weight control, increased physical activity, alcohol moderation, sodium reduction, and emphasis on increased consumption of fresh fruits, vegetables, and low-fat dairy products 1.
Special Considerations
- In people with diabetes mellitus, initiate antihypertensive drug treatment if systolic blood pressure is sustained ≥ 140 mm Hg or diastolic blood pressure is sustained ≥ 90 mm Hg 1.
- In elderly hypertensive patients, blood pressure should be lowered gradually to avoid complications 1.
- Resistant hypertension should be managed in specialist centers with sufficient expertise, and resources necessary to diagnose and treat this condition 1.
From the Research
Treatment Recommendations
The manuscript identified by PMID 35504977 is not directly available, but based on the provided studies, we can discuss treatment recommendations for hypertension.
- The combination of an ACE inhibitor and a calcium channel blocker is considered an optimal combination for the treatment of hypertension 2.
- This combination is particularly recommended for patients with uncontrolled hypertension, cardiovascular risk factors, or those at a higher risk of diabetes mellitus 2.
- Calcium channel blockers have been shown to be effective in treating hypertension, with verapamil, diltiazem, and nifedipine being commonly used 3.
- The choice of antihypertensive medication may depend on the patient's specific condition, such as obstructive sleep apnea, where beta-1 antagonists, ACE inhibitors, and angiotensin II blocking drugs may be effective 4.
Patient-Specific Recommendations
- For patients with diabetes mellitus, the target blood pressure values are < 130/80 mm Hg, and combination therapy may be indicated 2.
- Patients with target organ damage, kidney or cardiovascular disease, or an overall cardiovascular risk according to the SCORE ≥ 5% may also benefit from combination therapy 2.
- In elderly patients with systolic hypertension, diuretics and calcium-blocking drugs may be more effective at lowering systolic blood pressure 5.
Combination Therapy
- Combination therapy is often necessary to achieve goal blood pressure levels, especially in patients with resistant hypertension 5.
- The use of fixed combinations, such as ACE inhibitors and calcium channel blockers, can increase compliance with treatment by reducing the number of pills taken by patients 2.