How would you treat hypertension with a blood pressure reading of 167 millimeters of mercury (mmHg)?

From the Guidelines

A blood pressure of 167 systolic requires immediate treatment as it falls into the hypertension range, and I recommend starting with lifestyle modifications and medication to reduce the risk of cardiovascular complications. The goal of treatment is to reduce blood pressure below 130/80 mmHg, which can be achieved through a combination of lifestyle changes and pharmacological therapy 1. Lifestyle modifications should include:

• Reducing sodium intake to less than 2300mg daily
• Regular aerobic exercise for 30 minutes most days
• Weight loss if overweight
• Limiting alcohol consumption
• Adopting the DASH diet rich in fruits, vegetables, and low-fat dairy For medication, a first-line agent would be a thiazide diuretic like hydrochlorothiazide 12.5-25mg daily, an ACE inhibitor like lisinopril 10mg daily, or a calcium channel blocker like amlodipine 5mg daily 1. It is essential to monitor blood pressure regularly at home with a validated device, taking readings in the morning and evening, and to follow up with a healthcare provider in 2-4 weeks to assess effectiveness and adjust dosage if needed 1. Hypertension treatment is crucial because sustained high blood pressure damages blood vessels over time, increasing the risk of heart attack, stroke, kidney disease, and other complications, and multiple medications may eventually be needed to achieve target blood pressure 1. Some key points to consider in the treatment of hypertension include:
• The importance of lifestyle modifications in lowering blood pressure and enhancing the effectiveness of antihypertensive medications
• The need for prompt initiation and timely titration of pharmacologic therapy to achieve blood pressure goals
• The use of drug classes demonstrated to reduce cardiovascular events in patients with diabetes, such as ACE inhibitors, angiotensin receptor blockers, thiazide-like diuretics, or dihydropyridine calcium channel blockers
• The potential need for multiple-drug therapy to achieve blood pressure targets
• The importance of monitoring renal function and serum potassium levels when using ACE inhibitors or ARBs 1.

From the FDA Drug Label

The magnitude of reduction in blood pressure with amlodipine is also correlated with the height of pretreatment elevation; thus, individuals with moderate hypertension (diastolic pressure 105 to 114 mmHg) had about a 50% greater response than patients with mild hypertension (diastolic pressure 90 to 104 mmHg) Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure.

To treat hypertension with a blood pressure reading of 167 mmHg, antihypertensive medication such as amlodipine or lisinopril may be considered.

• Amlodipine is a peripheral arterial vasodilator that acts directly on vascular smooth muscle to cause a reduction in peripheral vascular resistance and reduction in blood pressure.
• Lisinopril is indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. The choice of medication and dosage should be determined by a healthcare professional based on individual patient needs and medical history 2 3.

From the Research

Treatment Options for Hypertension

To treat hypertension with a blood pressure reading of 167 mmHg, the following options can be considered:

• Lifestyle modifications, such as diet adaptation, sodium reduction, alcohol restriction, physical exercise, and weight reduction, as recommended by various guidelines 4, 5
• The Dietary Approaches to Stop Hypertension (DASH) diet, which has been shown to reduce blood pressure significantly 4, 6
• Regular exercise, such as brisk walking, which can reduce blood pressure by up to 5 mmHg 7
• Combination therapy with antihypertensive agents, such as valsartan, amlodipine, and hydrochlorothiazide, which can provide better blood pressure control 8

Lifestyle Modifications

Lifestyle modifications are crucial in the treatment of hypertension and can be recommended as first-line treatment for patients with high-normal blood pressure or grade 1 hypertension without high risk factors 4. These modifications include:

• Diet adaptation containing low sodium and alcohol restriction
• Physical exercise, such as aerobic or resistance exercise, for at least 30 minutes a day
• Weight reduction, aiming for a body mass index (BMI) of less than 25 kg/m2
• Increased intake of vegetables, fruit, and fish (fish oil)
• Reduced intake of cholesterol and saturated fatty acids

Medication Therapy

For patients who require medication, combination therapy with antihypertensive agents can be effective in controlling blood pressure 8. The use of a single pill containing multiple agents, such as amlodipine, valsartan, and hydrochlorothiazide, can simplify therapy and improve blood pressure control. Lifestyle modifications can also enhance the effects of antihypertensive therapy 4.