What are the recommended treatments for managing hypertension?

From the Guidelines

Hypertension management should involve both lifestyle modifications and medication therapy, with a focus on reducing morbidity, mortality, and improving quality of life. The most recent and highest quality study, 1, recommends lifestyle intervention consisting of weight loss, a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern, moderation of alcohol intake, and increased physical activity for patients with blood pressure >120/80 mmHg. Key lifestyle changes 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
• Quitting smoking 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 25-100 mg daily
• Calcium channel blockers, such as amlodipine 5-10 mg daily Treatment should typically begin with a single agent at a low dose, with adjustments based on blood pressure response, and many patients require two or more medications to achieve target blood pressure levels below 130/80 mmHg 1. Regular monitoring of blood pressure and kidney function is essential, and treatment is typically lifelong to prevent complications like heart disease, stroke, and kidney damage. It is also important to note that the choice of antihypertensive therapy should be based on the individual patient's needs and medical history, and that lifestyle therapy should be developed in collaboration with the patient and discussed as part of diabetes management 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 1 drug to achieve blood pressure goals. 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 recommended treatments for managing hypertension include:

• Comprehensive cardiovascular risk management: lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake
• Antihypertensive drugs: from a variety of pharmacologic classes, such as losartan 2 and lisinopril 3
• Combination therapy: many patients will require more than one drug to achieve blood pressure goals The goal of treatment is to reduce blood pressure and decrease the risk of cardiovascular events, such as stroke and myocardial infarction 2

From the Research

Hypertension Management

Hypertension, also known as high blood pressure, is a significant health concern that affects millions of people worldwide. Managing hypertension is crucial to prevent cardiovascular disease, heart failure, and stroke. The recommended treatments for managing hypertension include:

• Lifestyle Modifications:
  • Weight loss for overweight individuals 4, 5, 6
  • Regular physical activity 4, 5, 6
  • Healthy dietary pattern with low sodium and high potassium intake 4, 5, 6
  • Moderation or elimination of alcohol consumption 4, 5, 6
  • Stress reduction techniques 5
• Pharmacologic Therapy:
  • First-line drug therapy includes thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and calcium channel blockers 4, 7
  • The choice of antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk 4
• Combination Therapy:
  • Lifestyle modifications and pharmacologic therapy can be used in combination to achieve optimal blood pressure control 4, 8
  • The use of combination antihypertensive drugs as first-line therapy has not been evaluated in terms of the complications of hypertension, except for certain diuretic-based combinations 7

Blood Pressure Targets

The target blood pressure levels for adults with hypertension are:

• Less than 130/80 mmHg for adults under 65 years 4
• Less than 130 mmHg for adults 65 years and older 4

Importance of Lifestyle Interventions

Lifestyle interventions, such as those described in the continuous care model (CCM), can be effective in reducing dietary sodium intake and blood pressure in patients with hypertension 8. These interventions should be recommended to improve patient adherence to dietary restrictions and treatment outcomes.