Management of Hypertension with Blood Pressure of 159 mmHg
For a patient with hypertension and a blood pressure reading of 159 mmHg systolic, prompt initiation of both lifestyle therapy and dual antihypertensive medication therapy is strongly recommended. 1, 2
Initial Treatment Approach
- Blood pressure of 159 mmHg systolic falls into the range of 140-159 mmHg, which is classified as Stage 2 hypertension requiring immediate intervention 3, 2
- For patients with BP between 140/90 mmHg and 159/99 mmHg, treatment should begin with a single antihypertensive medication along with lifestyle modifications 3
- For patients with BP ≥160/100 mmHg, initial pharmacologic treatment with two antihypertensive medications is recommended to more effectively achieve adequate blood pressure control 3, 2
Pharmacological Therapy
- First-line drug classes include ACE inhibitors, angiotensin receptor blockers (ARBs), thiazide-like diuretics, and dihydropyridine calcium channel blockers 3, 2
- For most patients, an ACE inhibitor or ARB combined with either a thiazide-like diuretic or calcium channel blocker is recommended as initial therapy 1, 2
- For patients with diabetes or albuminuria (UACR ≥30 mg/g), an ACE inhibitor or ARB should be included in the initial regimen 3
- For patients with established coronary artery disease, ACE inhibitors or ARBs are recommended as first-line therapy for hypertension 3
- For Black patients, initial therapy should include either a calcium channel blocker or thiazide-like diuretic 1
Medication Examples
- Calcium channel blockers like amlodipine produce vasodilation resulting in reduction of blood pressure, with effectiveness maintained for at least 24 hours with once-daily dosing 4
- ARBs like losartan are indicated for the treatment of hypertension to lower blood pressure, which reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarction 5
Target Blood Pressure Goals
- For most adults with hypertension, the target blood pressure should be <140/90 mmHg 3
- For patients with diabetes, the target should be more aggressive: systolic BP of 130 mmHg and <130 mmHg if tolerated, but not <120 mmHg 3
- For older patients (≥65 years) with diabetes, target systolic BP should be in the range of 130-139 mmHg 3
- For patients with chronic kidney disease, target systolic BP should be 120-129 mmHg if tolerated 3
Lifestyle Modifications
- Dietary sodium restriction to less than 100 mmol/day (approximately 2.3g/day) is recommended 3, 1
- Regular physical activity (30-60 minutes of aerobic exercise 4-7 days per week) 3, 1
- Weight reduction to achieve ideal body weight (BMI 18.5-24.9 kg/m²) 3, 1
- Following the DASH diet (rich in fruits, vegetables, low-fat dairy products, dietary fiber, whole grains, and plant proteins) 3
- Limiting alcohol consumption (≤14 units/week for men, ≤9 units/week for women) 3, 1
- Stress management in selected individuals 3
Follow-up and Monitoring
- Reassess BP within 2-4 weeks after initiating therapy 1
- Monitor serum creatinine/eGFR and potassium levels within 2-4 weeks after starting ACE inhibitors, ARBs, or diuretics 3, 1
- Aim to achieve target BP within 3 months 1
- Consider home BP monitoring to assess treatment efficacy and improve adherence 1
Common Pitfalls to Avoid
- Delaying initiation of drug therapy in favor of lifestyle modifications alone for this level of hypertension 1
- Starting with monotherapy when combination therapy is indicated for BP readings near 160 mmHg 3, 2
- Combining two RAS blockers (ACE inhibitor with ARB), which is not recommended due to increased risk of adverse events (hyperkalemia, syncope, acute kidney injury) 3, 1
- Failing to assess medication adherence when BP remains uncontrolled 1
- Neglecting to screen for secondary causes in resistant cases 1