What are the new guidelines for hypertension (high blood pressure) management?

From the Guidelines

The latest blood pressure guidelines recommend maintaining blood pressure below 130/80 mmHg for most adults, with a focus on individualized treatment based on age, comorbidities, and other risk factors, as supported by the most recent evidence from the World Health Organization guideline executive summary 1.

Key Recommendations

• For initial treatment of hypertension, first-line medications include thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers, with the choice of medication guided by the patient's specific clinical profile and comorbidities 1.
• Lifestyle modifications are essential and include reducing sodium intake to less than 2,300 mg daily, following the DASH diet rich in fruits and vegetables, exercising regularly, limiting alcohol consumption, maintaining healthy weight, and quitting smoking.
• Home blood pressure monitoring is recommended, with readings taken at the same time daily, after 5 minutes of rest, with the arm supported at heart level, as outlined in the acc/aha guidelines 1.

Considerations for Treatment

• The benefit/harm ratio for overtreatment of BP was shown in recent analyses demonstrating that only those with >18% 10-year CV risk derived more benefit than harm from aggressive BP-lowering treatment 1.
• A more evidence-based statement for the guideline would have been to set the lower BP target for treatment at >15% 10-year CV risk, because all trials had cohorts with >15% CV risk 1.
• The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management, with a focus on standard approaches to pharmacological treatment and management of hypertension 1.

Important Factors to Consider

• The risk assessment approach has also been adopted by the American Diabetes Association and other groups, with the U.S. guidelines using the ASCVD risk calculator and the ESC/ESH guidelines recommending the use of the Systematic Coronary Risk Evaluation system 1.
• The impact of general as well as specific modifiers of CV risk for patients with hypertension is also acknowledged, with the ESC/ESH guidelines recommending that risk estimation be complemented by an assessment of hypertension-mediated organ damage 1.

From the Research

New Guidelines for Hypertension Management

The new guidelines for hypertension management recommend lifestyle modifications as the first-line treatment for patients with high-normal blood pressure or grade 1 hypertension without high risk factors 2. These modifications include:

• Diet adaptation, such as the Dietary Approaches to Stop Hypertension (DASH) diet
• Sodium reduction
• Alcohol restriction
• Physical exercise
• Weight reduction

Lifestyle Modifications

Lifestyle modifications are crucial in the treatment of hypertension and should be recommended to most hypertensive patients 2, 3. The benefits of lifestyle modifications include:

• Reducing blood pressure
• Enhancing the effects of antihypertensive therapy
• Decreasing the risk of cardiovascular disease (CVD) events

First-Line Therapy

First-line therapy for hypertension consists of lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 3. The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic CVD risk.

Non-Pharmacological Management

Non-pharmacological management of hypertension is an attractive approach for dealing with hypertension, with benefits including few or no side effects and additional health benefits 4. Non-pharmacological methods that effectively lower blood pressure include:

• Increased physical activity
• Weight loss
• Limited alcohol consumption
• Relaxation techniques, such as yoga and meditation

Physical Activity

Physical activity is a critical component of first-line treatment for elevated blood pressure or cholesterol 5. The American Heart Association recommends lifestyle approaches, including physical activity, to prevent and treat elevated blood pressure and cholesterol. Physical activity assessment and prescription are an excellent lifestyle behavior treatment option for all patients, including those with mild-moderate-risk blood pressure and cholesterol.