From the Guidelines
To manage hypertension, adopt a comprehensive approach combining lifestyle changes and medication if needed, prioritizing lifestyle intervention as the first line of treatment, as recommended by the most recent guidelines 1.
Key Lifestyle Interventions
- Reduce sodium intake to less than 2,300 mg daily
- Follow the DASH diet rich in fruits, vegetables, whole grains, and low-fat dairy
- Limit alcohol to no more than one drink daily for women or two for men
- Engage in regular physical activity of at least 150 minutes of moderate exercise weekly
- Aim to maintain a healthy weight, as losing even 5-10 pounds can significantly reduce blood pressure
Medication Considerations
If lifestyle modifications aren't sufficient, medications may be prescribed, including:
- Thiazide diuretics (like hydrochlorothiazide 12.5-25 mg daily)
- ACE inhibitors (such as lisinopril 10-40 mg daily)
- ARBs (like losartan 25-100 mg daily)
- Calcium channel blockers (such as amlodipine 5-10 mg daily) Monitoring blood pressure regularly at home, aiming for readings below 130/80 mmHg, is crucial for effective hypertension management 1.
Additional Considerations
- Use of internet or mobile-based digital platforms to reinforce healthy behaviors may be considered as a component of care 1
- Telehealth strategies, such as telemedicine, digital health, and use of mobile computing and communication technologies, can facilitate improvements in managing patients with hypertension 1
- Clinicians should ensure accurate office BP measurements, assess for nonadherence to prescribed antihypertensive medications, and obtain home or ambulatory BP readings to rule out the white coat effect in patients with resistant hypertension 1
From the FDA Drug Label
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 Many patients will require more than one drug to achieve blood pressure goals. 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)
To manage hypertension, comprehensive cardiovascular risk management is necessary, including:
- Lipid control
- Diabetes management
- Antithrombotic therapy
- Smoking cessation
- Exercise
- Limited sodium intake It is also important to note that many patients will require more than one drug to achieve blood pressure goals. For specific advice, it is recommended to consult 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) 2 3.
From the Research
Lifestyle Modifications for Hypertension Management
- Maintaining a healthy body weight, moderating alcohol consumption, exercising regularly, reducing sodium intake, and altering intake of calcium, magnesium, and potassium can help prevent and control hypertension 4
- Lifestyle modifications such as weight loss, regular exercise, and low alcohol consumption can reduce blood pressure in normotensive and hypertensive individuals 4
- A healthy lifestyle, including physical activity and a heart-healthy diet, can reduce dietary sodium intake and blood pressure in patients with hypertension 5
Dietary Interventions
- Reducing salt, sodium, and fat intake, and increasing consumption of fruits and vegetables can help lower blood pressure 6
- Supplementing the diet with potassium, calcium, and magnesium has not been associated with a clinically important reduction in blood pressure in people consuming a healthy diet 4
Physical Activity and Stress Management
- Regular physical exercise can reduce blood pressure and improve cardiovascular health 7
- Stress management, including cognitive behavior modification, can help reduce the negative effects of stress on blood pressure 4
- Promoting adequate sleep patterns and circadian entrainment can also help reduce blood pressure 7
Combination Therapy
- Combination therapy with agents having complementary mechanisms of action, such as a calcium channel blocker and an angiotensin II-receptor blocker, can be an effective treatment option for patients with stage 2 hypertension 8
- Lifestyle intervention, including dietary modifications and physical activity, can be used in conjunction with antihypertensive medications to improve treatment outcomes 6, 5