What are the current American Heart Association (AHA) guidelines for hypertension management?

From the Guidelines

The American Heart Association (AHA) recommends maintaining blood pressure below 130/80 mmHg for most adults, as stated in the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults 1.

Key Recommendations

• Treatment begins with lifestyle modifications including:
  • The DASH diet (rich in fruits, vegetables, whole grains, and low-fat dairy)
  • Reducing sodium intake to less than 2,300 mg daily
  • Regular physical activity (at least 150 minutes of moderate-intensity exercise weekly)
  • Limiting alcohol consumption
  • Maintaining a healthy weight
• For patients requiring medication, first-line options include:
  • Thiazide diuretics (like chlorthalidone 12.5-25 mg daily or hydrochlorothiazide 12.5-50 mg daily)
  • ACE inhibitors (such as lisinopril 10-40 mg daily)
  • ARBs (like losartan 50-100 mg daily)
  • Calcium channel blockers (amlodipine 2.5-10 mg daily)

Individualized Treatment

• Treatment should be individualized based on comorbidities, with more aggressive targets (below 130/80 mmHg) for those with diabetes, chronic kidney disease, or high cardiovascular risk 1.
• For older adults (65+ years), a slightly higher systolic target may be appropriate if treatment causes adverse effects.

Monitoring and Adjustment

• Regular blood pressure monitoring is essential, and medication adjustments should occur every 2-4 weeks until target blood pressure is achieved 1.

Goal of Treatment

• The goal of treatment is to reduce the risk of heart attacks, strokes, heart failure, and kidney disease by controlling hypertension, which is a major modifiable risk factor for cardiovascular disease.

From the Research

Current American Heart Association (AHA) Guidelines for Hypertension Management

The current AHA guidelines for hypertension management recommend the following:

• Lifestyle modifications as the first-line treatment for patients with high-normal blood pressure or grade 1 hypertension without high risk factors 2, 3
• Recommended lifestyle modifications include:
  • Diet adaptation, such as the Dietary Approaches to Stop Hypertension (DASH) diet 2, 3, 4
  • Sodium reduction 2, 3
  • Alcohol restriction 2, 3
  • Physical exercise 2, 3, 5
  • Weight reduction 2, 3
• For patients who need drug treatment, lifestyle changes can also enhance the effects of antihypertensive therapy 2, 3
• A blood pressure level goal of less than 130/80 mm Hg for adults with confirmed hypertension and without additional markers of increased atherosclerotic cardiovascular disease (ASCVD) risk may be reasonable 3
• Decisions regarding when to start antihypertensive drugs are based in part on cardiovascular risk 3
• Physical activity assessment and prescription are an excellent lifestyle behavior treatment option for all patients, including for the large population of mild-moderate-risk patients with elevated blood pressure and blood cholesterol 5