What are the guidelines for Hypertension (HTN) management in adults?

From the Guidelines

Hypertension in adults should be treated to a target systolic blood pressure of less than 150 mm Hg in adults aged 60 years or older, as recommended by the American College of Physicians and the American Academy of Family Physicians 1.

Treatment Approach

The treatment approach for hypertension in adults involves a combination of lifestyle modifications and pharmacologic interventions. Lifestyle modifications include weight loss, dietary changes such as the DASH diet, and increased physical activity 1. These modifications are effective in reducing blood pressure and have fewer side effects compared to pharmacologic therapies.

Pharmacologic Treatment

Pharmacologic treatment options for hypertension include thiazide-type diuretics, ACE inhibitors, ARBs, calcium-channel blockers, and β-blockers 1. The choice of medication depends on the individual patient's characteristics, including comorbidities and potential side effects.

Blood Pressure Measurement

Accurate measurement of blood pressure is essential before beginning or changing treatment for hypertension 1. This can be achieved through multiple measurements in clinical settings or ambulatory or home monitoring.

Treatment Goals

Treatment goals for adults with hypertension should be individualized based on age and comorbidities 1. For adults aged 60 years or older, the target systolic blood pressure is less than 150 mm Hg. Regular monitoring and medication adherence are crucial for successful blood pressure control, which significantly reduces the risk of stroke, heart attack, heart failure, and kidney disease.

Key Considerations

• Lifestyle modifications are the first line of treatment for hypertension and should be used in conjunction with pharmacologic therapies when necessary.
• Pharmacologic treatment options should be chosen based on individual patient characteristics and potential side effects.
• Accurate measurement of blood pressure is essential for diagnosing and managing hypertension.
• Treatment goals should be individualized based on age and comorbidities.

From the FDA Drug Label

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) Many patients will require more than 1 drug to achieve blood pressure goals. 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

The guidelines for Hypertension (HTN) in adults are found in 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) 23. Key aspects of HTN management include:

• Comprehensive cardiovascular risk management
• Lipid control
• Diabetes management
• Antithrombotic therapy
• Smoking cessation
• Exercise
• Limited sodium intake
• Many patients will require more than 1 drug to achieve blood pressure goals. No specific blood pressure goals are mentioned in the provided drug labels 233.

From the Research

Guidelines for Hypertension in Adults

• The treatment of hypertension reduces morbidity and mortality due to coronary artery disease, myocardial infarction, heart failure, stroke, and chronic kidney disease 4.
• Assessment of adults with hypertension should focus on identifying complications of the condition and comorbid cardiovascular risk factors 4.
• Physicians should counsel all patients with elevated blood pressure about effective lifestyle interventions, including:
  • Dietary Approaches to Stop Hypertension (DASH) diet
  • Dietary sodium restriction
  • Potassium enrichment
  • Regular exercise
  • Weight loss
  • Moderation of alcohol consumption 4, 5, 6, 7
• First-line antihypertensive medications include:
  • Angiotensin-converting enzyme inhibitors
  • Angiotensin receptor blockers
  • Calcium channel blockers
  • Thiazide diuretics 4, 8
• Thresholds for pharmacologic intervention and blood pressure goals differ according to various guidelines, but evidence strongly supports reducing blood pressure to less than 140/90 mm Hg to reduce the risk of all-cause and cardiovascular mortality in adults with hypertension 4.
• Lowering blood pressure to less than 135/85 mm Hg may further reduce the risk of myocardial infarction 4.

Lifestyle Interventions

• Lifestyle modifications, such as weight loss, regular exercise, and low alcohol consumption, can reduce blood pressure in normotensive and hypertensive individuals 5, 6, 7.
• Sodium restriction and stress management can also reduce blood pressure in hypertensive patients 5, 6, 7.
• Maintaining healthy lifestyle factors, such as a healthy body mass index, diet, smoking, alcohol consumption, sodium excretion, and sedentary behavior, can lower systolic blood pressure and reduce the risk of cardiovascular disease 7.

Antihypertensive Therapy

• Angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and calcium antagonists are effective and well-tolerated antihypertensive agents, but should be considered alternative drugs for first-line therapy until randomized trials show that they are at least as effective as diuretics and beta-blockers in preventing cardiovascular morbidity and mortality 8.
• Special indications for calcium antagonists in the management of hypertension include angina pectoris, paroxysmal supraventricular tachycardia, and atrial fibrillation with rapid ventricular rate 8.