What management is recommended for a 37-year-old individual with elevated blood pressure (hypertension) of 139/94 according to National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries (CKS)?

Management of Blood Pressure 139/94 in a 37-Year-Old Individual

For a 37-year-old fit and well individual with blood pressure of 139/94 mmHg, lifestyle modifications should be initiated for 3-6 months before considering pharmacological treatment, as this reading falls into the grade 1 (mild) hypertension category.

Blood Pressure Classification

• The reading of 139/94 mmHg falls into grade 1 (mild) hypertension category according to most guidelines 1
• This level is considered elevated and requires intervention to reduce cardiovascular disease (CVD) risk 1

Initial Management Approach

Lifestyle Modifications (First-Line)

Lifestyle modifications should be implemented for 3-6 months before considering pharmacological treatment for this patient:

• Regular physical activity: 30 minutes of moderate aerobic exercise (walking, jogging, cycling) 5-7 days per week plus resistance training 2-3 days per week 1, 2
• Dietary changes: Follow DASH diet rich in fruits, vegetables, whole grains, low-fat dairy, and reduced saturated fat 1, 3
• Salt reduction: Limit sodium intake to 1200-2300 mg/day 1
• Weight management: Aim for BMI 20-25 kg/m² and waist circumference <94 cm for men, <80 cm for women 1
• Alcohol moderation: Limit to 100g/week of pure alcohol (approximately 2 standard drinks daily for men, 1.5 for women) 1
• Smoking cessation: If applicable 1
• Stress reduction: Consider mindfulness or meditation practices 1

Monitoring During Lifestyle Modification Period

• Reassess blood pressure and cardiovascular risk after 3-6 months of consistent lifestyle modifications 1
• If BP remains elevated after this period, pharmacological treatment should be considered 1

When to Consider Pharmacological Treatment

For this 37-year-old with BP 139/94 mmHg, drug therapy would be indicated if:

• BP remains ≥140/90 mmHg after 3-6 months of lifestyle modifications 1
• The patient has high cardiovascular risk (10-year CVD risk ≥10%) 1
• The patient has existing cardiovascular disease, chronic kidney disease, diabetes, or hypertension-mediated organ damage 1

Treatment Target

If pharmacological treatment becomes necessary:

• The recommended target BP for most adults is 120-129 mmHg systolic if tolerated 1
• For adults under 65 years (like this patient), a target of <130/80 mmHg is appropriate 1

First-Line Pharmacological Options (If Needed)

If medication becomes necessary after the lifestyle modification period:

• First-line agents include ACE inhibitors, ARBs, dihydropyridine calcium channel blockers, or thiazide/thiazide-like diuretics 1, 4
• For most patients with confirmed hypertension ≥140/90 mmHg, combination therapy is recommended as initial treatment 1

Follow-up

• Annual reassessment of blood pressure and cardiovascular risk if deciding not to treat with medications initially 1
• If starting medications, follow-up within 1-2 months to assess efficacy and tolerability 1

Common Pitfalls to Avoid

• Ignoring white coat hypertension - consider home or ambulatory BP monitoring to confirm diagnosis 1
• Failing to assess for secondary causes of hypertension in young adults (<40 years) 1
• Underestimating the efficacy of lifestyle modifications - they can reduce systolic BP by approximately 5 mmHg and diastolic BP by 3 mmHg 2
• Starting pharmacological treatment prematurely before giving adequate trial of lifestyle modifications 1