From the Guidelines
The recommended treatment plan for hypertension involves both lifestyle modifications and medication therapy, with a focus on achieving a blood pressure goal of less than 130/80 mmHg, as recommended by the most recent guidelines 1.
Lifestyle Modifications
Lifestyle changes should include:
- Adopting the DASH diet, rich in fruits, vegetables, whole grains, and low-fat dairy
- Reducing sodium intake to less than 2,300 mg daily
- Regular physical activity, such as 150 minutes of moderate exercise weekly
- Limiting alcohol consumption
- Maintaining a healthy weight
- Smoking cessation These lifestyle interventions are reasonable for individuals with diabetes and mildly elevated blood pressure, and should be initiated along with pharmacologic therapy when hypertension is diagnosed 1.
Medication Therapy
For medications, first-line options include:
- Thiazide diuretics, such as hydrochlorothiazide 12.5-25 mg daily
- ACE inhibitors, such as lisinopril 10-40 mg daily
- Angiotensin II receptor blockers, such as losartan 50-100 mg daily
- Calcium channel blockers, such as amlodipine 5-10 mg daily Treatment typically begins with a single agent at a low dose, with adjustments based on blood pressure response. For stage 2 hypertension (BP ≥140/90 mmHg), combination therapy with two medications from different classes is often initiated 1.
Resistant Hypertension
In patients with resistant hypertension, the addition of low-dose spironolactone to existing treatment, or the addition of further diuretic therapy, should be considered 1.
Monitoring and Follow-up
Regular monitoring is essential, with a goal of achieving blood pressure below 130/80 mmHg for most adults. These interventions work by reducing vascular resistance, decreasing fluid volume, or reducing cardiac output, ultimately lowering the pressure within blood vessels and reducing strain on the heart.
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 1 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 recommended treatment plan for hypertension includes:
- Comprehensive cardiovascular risk management
- Lipid control
- Diabetes management
- Antithrombotic therapy
- Smoking cessation
- Exercise
- Limited sodium intake
- Medication: Many patients will require more than one drug to achieve blood pressure goals, such as lisinopril 2 2. It is recommended to 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
Treatment Plan for Hypertension
The recommended treatment plan for hypertension involves a combination of lifestyle modifications and medication.
- Lifestyle modifications are recommended as the first-line treatment for hypertension, and include:
- Diet adaptation, such as the Dietary Approaches to Stop Hypertension (DASH) diet, which is low in sodium and alcohol 3, 4, 5
- Weight loss, which can help reduce blood pressure 3, 4, 6, 5, 7
- Physical exercise, such as moderate-intensity exercise, which can help lower blood pressure 3, 4, 6, 5, 7
- Sodium reduction, which can help lower blood pressure 3, 4, 5
- Potassium supplementation, which may help lower blood pressure 4
- Smoking cessation, which can help reduce the risk of cardiovascular disease 3, 6
- Stress management, which may help lower blood pressure 3
- Medication may be necessary for patients who do not respond to lifestyle modifications, or who have high-risk factors.
- First-line medication options include:
Implementation of Treatment Plan
The treatment plan should be individualized to each patient's needs and risk factors.
- Patients with high-normal blood pressure or grade 1 hypertension without high-risk factors may be started on lifestyle modifications first, and medication may be added if necessary 3
- Patients who require medication should continue to make lifestyle modifications to enhance the effects of the medication 3, 4, 6