What are the current treatment guidelines for Hypertension (High Blood Pressure)?

From the Guidelines

Current hypertension treatment guidelines recommend a blood pressure target of less than 130/80 mmHg for most adults, with an initial target of less than 140/90 mmHg, and subsequent efforts to achieve a lower blood pressure in those 18 to 65 years of age, as tolerated 1.

Key Recommendations

• The American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/European Society of Hypertension (ESC/ESH) recommend lower blood pressure treatment targets compared to previous guidelines 1.
• For older adults (≥65 years), the target is systolic blood pressure (SBP) less than 130 mmHg, if tolerated, while for those with a high burden of comorbidity and limited life expectancy, treatment decisions should be based on clinical judgment, patient preference, and a team-based assessment of risk/benefit 1.
• The initial SBP/diastolic blood pressure (DBP) target is less than 140/90 mmHg for all adults with hypertension, with subsequent efforts to achieve a lower blood pressure in those 18 to 65 years of age, as tolerated 1.

Pharmacological Treatment

• First-line medications include thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers, or calcium channel blockers, with treatment often beginning with a single agent at a low dose, and adjustments based on response 1.
• Many patients require two or more medications to achieve target blood pressure, with combination therapy increasingly used as an initial approach 1.

Monitoring and Follow-up

• Regular monitoring is essential, with follow-up intervals ranging from 1 month to 1 year, depending on the severity of hypertension and the patient's response to treatment 1.
• The goal of treatment is to achieve blood pressure control, prevent complications, and improve quality of life, with individualized targets based on age, comorbidities, and medication tolerance 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 current treatment guidelines for Hypertension (High Blood Pressure) recommend:

• Comprehensive cardiovascular risk management
• Lipid control
• Diabetes management
• Antithrombotic therapy
• Smoking cessation
• Exercise
• Limited sodium intake
• Using more than one drug to achieve blood pressure goals if necessary
• 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) 2 3

From the Research

Current Treatment Guidelines for Hypertension

The current treatment guidelines for hypertension recommend a combination of lifestyle modifications and medication. The following are some of the key recommendations:

• Lifestyle modifications:
  • Diet adaptation, including the Dietary Approaches to Stop Hypertension (DASH) diet 4, 5, 6, 7
  • Sodium reduction 4, 5, 6, 7
  • Alcohol restriction 4, 5, 6, 7
  • Physical exercise 4, 5, 6, 7
  • Weight reduction 4, 5, 6, 7
• Medication:
  • For patients with high-normal blood pressure or grade 1 hypertension without high risk factors, lifestyle medicine should be used first for 3-6 months, and then medication should be started if blood pressure is still not controlled 4
  • For patients who need drug treatment, lifestyle changes can also enhance the effects of antihypertensive therapy 4, 5
  • Most hypertensive patients will need at least two drugs to control blood pressure 5
  • Combination therapy using different classes of medications, such as thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs) 8

Blood Pressure Goals

The recommended blood pressure goal is less than 130/80 mm Hg for adults with confirmed hypertension and without additional markers of increased atherosclerotic cardiovascular disease (ASCVD) risk 5

Patient Management

Pharmacists can play an important role in managing patients with hypertension by managing their medications and lifestyle behaviors 7 Decisions regarding when to start antihypertensive drugs are based in part on cardiovascular risk 5