What is the management approach for patients with hypertension regarding blood pressure control?

From the Guidelines

Blood pressure management for patients with hypertension should aim for a target of less than 130/80 mmHg for most adults, as recommended by the most recent guidelines 1. The management approach for patients with hypertension involves a combination of lifestyle modifications and medication therapy.

• Lifestyle modifications include:
  • Weight loss if overweight or obese
  • Adopting a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern, including reducing sodium and increasing potassium intake
  • Moderation of alcohol intake
  • Increased physical activity, such as 150 minutes of moderate-intensity exercise weekly
• If lifestyle modifications are insufficient after 3-6 months or if initial blood pressure is significantly elevated, medication therapy should be initiated.
• First-line medications include:
  • Thiazide diuretics, such as chlorthalidone 12.5-25 mg daily or hydrochlorothiazide 12.5-50 mg daily
  • Calcium channel blockers, such as amlodipine 2.5-10 mg daily
  • ACE inhibitors, such as lisinopril 10-40 mg daily
  • ARBs, such as losartan 25-100 mg daily Many patients will require combination therapy with two or more medications from different classes to achieve target blood pressure, as supported by the guidelines 1. Regular monitoring is essential, with home blood pressure measurements providing valuable data between office visits, and medication adjustments should be made every 2-4 weeks until blood pressure goals are achieved, as recommended by the guidelines 1. The most recent and highest quality study 1 provides the best evidence for the management of hypertension, and its recommendations should be prioritized in clinical practice.

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 1 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 management approach for patients with hypertension regarding blood pressure control involves comprehensive cardiovascular risk management. This includes:

• Lipid control
• Diabetes management
• Antithrombotic therapy
• Smoking cessation
• Exercise
• Limited sodium intake It is also noted that many patients will require more than one drug to achieve blood pressure goals. For specific advice, it is recommended to consult published guidelines such as those from 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

Management Approach for Patients with Hypertension

The management approach for patients with hypertension regarding blood pressure control involves a combination of lifestyle modifications and pharmacologic therapy.

• Lifestyle modifications are recommended as the first-line approach for the management of high blood pressure, and include:
  • Weight loss
  • Healthy dietary pattern with low sodium and high potassium intake
  • Physical activity
  • Moderation or elimination of alcohol consumption
  • Stress management and sleep levels management
  • Avoidance and cessation of smoking 4, 5, 6, 7
• Pharmacologic therapy is initiated based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk, and includes:
  • Thiazide or thiazide-like diuretics
  • Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers
  • Calcium channel blockers
  • These medications should be titrated according to office and home blood pressure levels to achieve the target blood pressure 4
• The target blood pressure is less than 130/80 mmHg for adults under 65 years and less than 130 mmHg for adults 65 years and older 4
• Lifestyle modifications should be continued even when blood pressure-lowering medications are prescribed, as they can enhance the efficacy of pharmacologic therapy and minimize the number and dose of medications required 4, 5, 6, 7
• Randomized clinical trials have established the efficacy of blood pressure lowering to reduce the risk of cardiovascular disease morbidity and mortality, with an systolic blood pressure reduction of 10 mmHg decreasing the risk of cardiovascular disease events by approximately 20% to 30% 4
• Non-pharmacological management of hypertension, including lifestyle modifications, is an attractive approach for dealing with hypertension, especially in developing countries, due to its economic limitations and additional benefits with few or almost no side effects 7
• Specific lifestyle modifications, such as increased physical activity, weight loss, limited alcohol consumption, relaxation techniques, and avoidance of air pollution, can effectively lower blood pressure and reduce the risk of cardiovascular disease 8, 7