From the Guidelines
To manage high blood pressure effectively, adopt a comprehensive approach combining lifestyle modifications and medication when necessary, prioritizing lifestyle intervention as the initial step, as recommended by the most recent guidelines 1.
Lifestyle Modifications
The management of hypertension should start with lifestyle modifications, including:
- Reducing sodium intake to less than 2,300mg daily
- Increasing physical activity to at least 150 minutes of moderate exercise weekly
- Maintaining a healthy weight
- Limiting alcohol consumption to no more than 2 servings per day in men and no more than 1 serving per day in women
- Following the DASH diet rich in fruits, vegetables, whole grains, and low-fat dairy These lifestyle interventions are reasonable for individuals with mildly elevated blood pressure and should be initiated along with pharmacologic therapy when hypertension is diagnosed 1.
Medication
For medications, first-line options include:
- Thiazide diuretics (like hydrochlorothiazide 12.5-25mg daily)
- ACE inhibitors (such as lisinopril 10-40mg daily)
- ARBs (like losartan 25-100mg daily)
- Calcium channel blockers (amlodipine 5-10mg daily) Treatment goals typically aim for blood pressure below 130/80 mmHg, though targets may vary based on age and comorbidities 2.
Monitoring and Follow-up
Regular home monitoring is essential, using a validated upper-arm cuff device and measuring at the same time daily 3. These approaches work by reducing fluid volume, relaxing blood vessels, or decreasing heart workload, ultimately lowering the pressure of blood against vessel walls and reducing strain on the cardiovascular system. It is crucial to develop a lifestyle therapy plan in collaboration with the patient and discuss it as part of diabetes management, considering the use of internet or mobile-based digital platforms to reinforce healthy behaviors 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 management of hypertension (high blood pressure) involves:
- Comprehensive cardiovascular risk management
- Lifestyle modifications, including: + Lipid control + Diabetes management + Antithrombotic therapy + Smoking cessation + Exercise + Limited sodium intake
- Pharmacological therapy, with many patients requiring more than one drug to achieve blood pressure goals
- 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) [4] [5]
From the Research
Management of Hypertension
The management of hypertension involves a combination of lifestyle modifications and pharmacological interventions.
- 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 6, 7, 8 + Sodium reduction 6, 7, 8, 9 + Alcohol restriction 6, 7, 8, 9 + Physical exercise 6, 10, 7, 9 + Weight reduction 6, 10, 7, 9
- Pharmacological interventions are recommended when lifestyle modifications are not sufficient to control blood pressure, and include: + Thiazide or thiazide-like diuretics 7, 8 + Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 7, 8 + Calcium channel blockers 7, 8 ### Treatment Approach The approach to treatment of hypertension depends on the level of blood pressure and the presence of high-risk factors.
- For patients with high-normal blood pressure or grade 1 hypertension without high-risk factors, lifestyle modifications are recommended as the first-line treatment for 3-6 months, and medication is started if blood pressure is still not controlled 6
- For patients with resistant hypertension, lifestyle modifications can be added to optimized medical therapy to reduce blood pressure and improve cardiovascular risk biomarkers 10 ### Goals of Treatment The goals of treatment for hypertension include:
- Reducing systolic blood pressure to less than 130 mm Hg and diastolic blood pressure to less than 80 mm Hg in most adults 7
- Reducing the risk of cardiovascular disease events, such as coronary heart disease, heart failure, and stroke 7