How to treat hypertension?

Treatment of Hypertension with BP 132/93 mmHg

Your blood pressure of 132/93 mmHg indicates hypertension that requires immediate lifestyle modifications and pharmacological treatment to reduce cardiovascular risk and mortality. 1

Diagnosis and Classification

Your blood pressure reading of 132/93 mmHg meets the criteria for hypertension:

• Systolic BP of 132 mmHg falls in the high-normal range (130-139 mmHg)
• Diastolic BP of 93 mmHg exceeds the hypertension threshold (≥90 mmHg)

This combination classifies as Grade 1 Hypertension according to the 2020 International Society of Hypertension guidelines 1.

Treatment Approach

Step 1: Lifestyle Modifications (Start Immediately)

All patients with hypertension should implement the following lifestyle changes:

• Weight management: Aim for a healthy BMI (20-25 kg/m²) and waist circumference (<94 cm for men, <80 cm for women) 1
• Dietary changes:
  • Follow DASH or Mediterranean diet pattern
  • Reduce sodium intake (<2,300 mg/day)
  • Increase potassium intake through fruits and vegetables (8-10 servings daily)
  • Limit free sugar consumption, especially sugar-sweetened beverages 1
• Physical activity:
  • At least 150 minutes/week of moderate aerobic exercise (30 min, 5-7 days/week) or 75 minutes/week of vigorous exercise
  • Include resistance training 2-3 times weekly 1
• Alcohol moderation:
  • Men: <14 units/week
  • Women: <8 units/week
  • Preferably avoid alcohol completely for best health outcomes 1
• Smoking cessation: If applicable 1

Step 2: Pharmacological Treatment (Start Immediately)

With a diastolic BP of 93 mmHg, immediate drug treatment is indicated alongside lifestyle modifications 1:

First-line therapy options:

1. For non-Black patients:

   • Start with low-dose ACE inhibitor (e.g., lisinopril) or ARB (e.g., losartan)
   • Consider combination with dihydropyridine calcium channel blocker (e.g., amlodipine)

2. For Black patients:

   • Start with low-dose ARB plus dihydropyridine calcium channel blocker or
   • Dihydropyridine calcium channel blocker plus thiazide/thiazide-like diuretic 1

Specific medication considerations:

• ACE inhibitors like lisinopril are indicated for hypertension and reduce cardiovascular events 2
• ARBs like losartan are effective alternatives, especially for patients who cannot tolerate ACE inhibitors 3
• Single-pill combinations improve adherence and should be considered 1

Blood Pressure Targets

Target blood pressure:

• For most adults: <130/80 mmHg 1
• Specifically aim for systolic BP of 120-129 mmHg if tolerated 1

Monitoring and Follow-up

1. Short-term follow-up:

   • Reassess BP control within 3 months of starting treatment
   • Aim to achieve target BP within this timeframe 1

2. Long-term monitoring:

   • Regular BP measurements (office and home)
   • Monitor for medication side effects
   • Assess for target organ damage

Special Considerations

• Resistant hypertension: If BP remains uncontrolled on three medications, consider adding spironolactone or, if not tolerated, eplerenone, amiloride, doxazosin, or beta-blocker 1

• Comorbidities: Treatment may need adjustment for conditions like diabetes, chronic kidney disease, or heart failure 1

Common Pitfalls to Avoid

1. Delayed treatment: With diastolic BP >90 mmHg, don't delay pharmacological therapy while waiting for lifestyle modifications to take effect

2. Inadequate dosing: Titrate medications to effective doses before adding new agents

3. Poor adherence: Use once-daily dosing and fixed-dose combinations when possible

4. White coat hypertension: Consider home or ambulatory BP monitoring to confirm diagnosis if suspected 1

5. Ignoring secondary causes: Consider evaluation for secondary hypertension if BP is difficult to control or onset is sudden 1

Remember that hypertension is the most important modifiable risk factor for cardiovascular disease 4, and proper treatment significantly reduces morbidity and mortality.