What is the treatment for hypertension?

From the Guidelines

Hypertension treatment typically involves lifestyle modification and, if necessary, pharmacotherapy.

Treatment Overview

• Lifestyle modification is the initial treatment approach, focusing on:
  • Healthy nutrition
  • Physical activity
  • Sleep
  • Weight management, if appropriate
• Pharmacologic treatment should be considered if lifestyle intervention is insufficient to reach target blood pressure levels, typically for patients with blood pressure > 140/80 mmHg 1.

Lifestyle Intervention

• Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern, including:
  • Reducing sodium intake (< 2,300 mg/day)
  • Increasing potassium intake
  • Increasing consumption of fruits and vegetables (8–10 servings per day) and low-fat dairy products (2–3 servings per day)
• Moderation of alcohol intake (no more than 2 servings per day in men and no more than 1 serving per day in women)
• Increased physical activity

Pharmacologic Treatment

• Should be considered in addition to lifestyle modification for patients with confirmed blood pressure higher than 140/80 mmHg 1
• Prompt initiation and timely subsequent titration of pharmacological therapy to achieve blood pressure goals is recommended 1

From the Research

Treatment Options for Hypertension

The treatment for hypertension typically involves a combination of lifestyle modifications and pharmacological therapy.

• Lifestyle modifications include:
  • Weight loss
  • Healthy dietary pattern with low sodium and high potassium intake
  • Physical activity
  • Moderation or elimination of alcohol consumption as stated in the study 2
• First-line drug therapy for hypertension consists of:
  • Thiazide or thiazide-like diuretics such as hydrochlorothiazide or chlorthalidone
  • Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers such as enalapril or candesartan
  • Calcium channel blockers such as amlodipine as mentioned in the study 2

Combination Therapy

More than 70% of adults treated for primary hypertension will eventually require at least two antihypertensive agents, either initially as combination therapy or as add-on therapy if monotherapy and lifestyle modifications do not achieve adequate blood pressure control 3.

• Four main classes of medications are used in combination therapy for the treatment of hypertension:
  • Thiazide diuretics
  • Calcium channel blockers
  • Angiotensin-converting enzyme inhibitors (ACEIs)
  • Angiotensin receptor blockers (ARBs) as stated in the study 3

Treatment Goals

The main goal of antihypertensive treatment is to prevent or to arrest cardiovascular damage 4.

• The ultimate goal of treatment strategies is the reduction of the excess of cardiovascular mortality and morbidity related to chronically elevated BP 5
• BP targets to be achieved by the treatment in the general hypertensive population and in specific clinical settings are:
  • SBP/DBP target (<130/80 mm Hg for adults <65 years and SBP <130 mm Hg in adults ≥65 years) as mentioned in the study 2

Special Considerations

• In black patients, at least one agent should be a thiazide diuretic or a calcium channel blocker 3
• Patients with heart failure with reduced ejection fraction should be treated initially with a beta blocker and an ACEI or ARB (or an angiotensin receptor-neprilysin inhibitor), followed by add-on therapy with a mineralocorticoid receptor antagonist and a diuretic based on volume status 3
• Treatment for patients with chronic kidney disease and proteinuria should include an ACEI or ARB plus a thiazide diuretic or a calcium channel blocker 3