What is the management for a blood pressure reading of 150/100 mmHg, indicating Hypertension?

Management of Hypertension with Blood Pressure 150/100 mmHg

For a blood pressure reading of 150/100 mmHg, immediate initiation of both pharmacological treatment and lifestyle modifications is recommended to reduce cardiovascular morbidity and mortality. 1

Classification and Risk Assessment

• A blood pressure of 150/100 mmHg is classified as Stage 2 hypertension according to current guidelines, requiring prompt intervention 1
• This level of blood pressure significantly increases cardiovascular risk and warrants immediate treatment 2, 1
• A comprehensive cardiovascular risk assessment using appropriate risk calculators (such as SCORE2 for ages 40-69 or SCORE2-OP for ≥70 years) should be performed to guide treatment intensity 2

Immediate Management Approach

• For BP ≥140/90 mmHg, especially with readings of 150/100 mmHg, immediate initiation of drug treatment along with lifestyle interventions is recommended 2, 1
• The goal is to reduce BP by at least 20/10 mmHg, with a target of <130/80 mmHg for most adults if tolerated 1, 2
• For older adults (≥65 years), a target systolic BP range of 130-139 mmHg is recommended 2

Pharmacological Treatment

First-line Medications:

• Begin with a combination of two first-line agents from different classes for most patients with Stage 2 hypertension 1
• Recommended first-line agents include:
  • ACE inhibitors (e.g., lisinopril) or ARBs 3
  • Calcium channel blockers (e.g., amlodipine) 4
  • Thiazide or thiazide-like diuretics 2, 5

Treatment Algorithm:

1. Start with two medications at low doses (e.g., ACE inhibitor/ARB plus calcium channel blocker or thiazide diuretic) 2
2. If BP remains uncontrolled after 2-4 weeks, increase to full doses 2
3. If target BP is still not achieved, add the third first-line agent 2
4. For resistant hypertension, consider adding spironolactone or other agents (doxazosin, eplerenone, clonidine, or beta-blocker) 2

Lifestyle Modifications

Implement these concurrently with medication therapy:

• Weight reduction to achieve healthy BMI (20-25 kg/m²) 2
• Adopt a DASH-style eating pattern with increased vegetables, fruits, and low-fat dairy 2
• Sodium restriction (<2,300 mg/day) and increased potassium intake 2
• Regular aerobic exercise (≥150 minutes/week of moderate intensity or 75 minutes/week of vigorous activity) 2
• Limit alcohol consumption (≤14 units/week for men, ≤8 units/week for women) 2

Monitoring and Follow-up

• Reassess BP within 2-4 weeks after initiating therapy 1
• Aim to achieve target BP within 3 months 2
• Monitor for medication side effects and adjust therapy as needed 2
• Evaluate for potential secondary causes if BP remains difficult to control despite adherence to a multi-drug regimen 2

Special Considerations

• For patients with diabetes: Target systolic BP to 130 mmHg and <130 mmHg if tolerated, but not <120 mmHg 2
• For patients with chronic kidney disease: Target systolic BP to 120-129 mmHg if eGFR >30 mL/min/1.73 m² 2
• For pregnant women: Initiate drug treatment when BP ≥140/90 mmHg 2

Common Pitfalls to Avoid

• Therapeutic inertia (failure to intensify treatment when BP remains uncontrolled) 1
• Inadequate dosing or inappropriate drug combinations 1
• Failing to address medication adherence issues 1
• Not considering white-coat hypertension (consider home or ambulatory BP monitoring to confirm diagnosis) 2
• Neglecting to evaluate for secondary causes when BP is difficult to control 2