From the Guidelines
Controlling blood pressure effectively requires a combination of lifestyle modifications and, when necessary, medication, with a focus on achieving a blood pressure target of less than 130/80 mm Hg for individuals with diabetes or chronic kidney disease, as recommended by the most recent guidelines 1. The most important lifestyle changes include:
- Maintaining a healthy weight through regular physical activity (aim for at least 150 minutes of moderate exercise weekly)
- Following the DASH diet, which emphasizes fruits, vegetables, whole grains, and low-fat dairy while limiting sodium to less than 2,300 mg daily
- Reducing alcohol consumption (no more than 1-2 drinks per day)
- Quitting smoking
- Managing stress through techniques like meditation or deep breathing For medication, first-line treatments often include:
- Thiazide diuretics (like hydrochlorothiazide 12.5-25 mg daily)
- ACE inhibitors (such as lisinopril 10-40 mg daily)
- ARBs (like losartan 25-100 mg daily)
- Calcium channel blockers (such as amlodipine 5-10 mg daily) These medications work by either reducing fluid volume, relaxing blood vessels, or decreasing heart rate, as supported by recent evidence 1. Regular blood pressure monitoring at home (using a validated upper-arm cuff device) and maintaining consistent medication schedules are essential for successful management, with a focus on achieving the recommended blood pressure targets, as outlined in the guidelines 1. Key considerations in blood pressure management include:
- Initiating lifestyle modifications for all patients with hypertension
- Adding blood pressure medication as tolerated for patients with blood pressure greater than or equal to 140/90 mm Hg (or greater than or equal to 130/80 mm Hg for individuals with chronic kidney disease or diabetes mellitus)
- Monitoring renal function and serum potassium levels when using ACE inhibitors, ARBs, or diuretics
- Referring patients who do not achieve target blood pressure despite multiple-drug therapy to a physician specializing in the care of patients with hypertension.
From the Research
Recommended Strategies for Controlling Blood Pressure
The following strategies are recommended for controlling blood pressure:
- Maintaining a healthy body weight through weight loss or maintenance of a healthy body mass index (BMI) 2
- Limiting alcohol consumption to 2 or fewer standard drinks per day, with a maximum of 14 drinks per week for men and 9 drinks per week for women 2, 3
- Engaging in regular physical activity, such as 30-60 minutes of aerobic exercise on 4-7 days of the week 4, 3
- Restricting sodium intake 2, 3
- Following a diet that emphasizes fruits, vegetables, and low-fat dairy products, such as the DASH diet 5, 3
- Considering stress management in selected individuals 2, 3
Lifestyle Modifications for Blood Pressure Control
Lifestyle modifications can be effective in controlling blood pressure, including:
- Weight loss and maintenance of a healthy body weight 2, 6
- Increased physical activity, such as walking or cycling, for 50-60 minutes, 3-4 times per week 4
- Restricting sodium intake and following a low-sodium diet 2, 6
- Limiting alcohol consumption and avoiding excessive alcohol intake 2, 3
- Engaging in stress management techniques, such as cognitive behavior modification 2
Benefits of Lifestyle Modifications
The benefits of lifestyle modifications for blood pressure control include: