What is the diagnosis and treatment for Hypertension (High Blood Pressure)?

From the Guidelines

Hypertension management should prioritize a blood pressure target of less than 130/80 mmHg for most adults, with initial pharmacological treatment guided by the 2021 WHO Guidelines, which recommend starting treatment at a BP threshold of 140/90 mmHg or higher in non-pregnant adults 1. The management of hypertension involves a comprehensive approach, including lifestyle modifications and pharmacological treatment. Lifestyle modifications are crucial and include reducing sodium intake, adopting a healthy diet such as the DASH diet, engaging in regular physical activity, limiting alcohol consumption, and maintaining a healthy weight.

• Key lifestyle modifications:
  • Reducing sodium intake to less than 2,300 mg daily
  • Adopting the DASH diet rich in fruits and vegetables
  • Regular physical activity of at least 150 minutes per week
  • Limiting alcohol consumption
  • Maintaining a healthy weight For pharmacological treatment, first-line options, as recommended by the WHO, include thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers 1.
• First-line medication options:
  • 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 (amlodipine 5-10 mg daily) It is essential to individualize treatment targets based on age and comorbidities, and medication adherence is crucial for effective blood pressure control 1. Regular home blood pressure monitoring is also recommended for patients with hypertension. The 2021 WHO Guidelines provide the most current evidence-based guidance for the pharmacological treatment of hypertension in non-pregnant adults, with a focus on practice in middle- and low-income countries 1.

From the FDA Drug Label

Losartan is indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older, to lower blood pressure. Amlodipine besylate is a type of medicine known as a calcium channel blocker (CCB). It is used to treat high blood pressure (hypertension) and a type of chest pain called angina.

Hypertension Treatment:

• Losartan and amlodipine are both indicated for the treatment of hypertension.
• Losartan is used to lower blood pressure in adults and pediatric patients 6 years of age and older 2.
• Amlodipine besylate is used to treat high blood pressure (hypertension) by relaxing blood vessels, which lets blood flow more easily and helps lower blood pressure 3.
• Both medications can be used to reduce the risk of stroke and heart attack associated with high blood pressure.
• The choice of therapy may depend on individual patient factors, such as the presence of left ventricular hypertrophy or diabetic nephropathy, and should be guided by published guidelines and clinical judgment.

From the Research

Definition and Prevalence of Hypertension

• Hypertension is defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg 4
• It affects approximately 116 million adults in the US and more than 1 billion adults worldwide 4
• Hypertension is associated with increased risk of cardiovascular disease (CVD) events and death 4

Lifestyle Modifications for Hypertension

• First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 4, 5
• The Dietary Approaches to Stop Hypertension (DASH) eating plan and sodium restriction are recommended for proper nutrition 5, 6
• Regular exercise and moderate weight loss are also associated with improvements in blood pressure 6, 7
• Stress management and promotion of adequate sleep patterns coupled with circadian entrainment are also beneficial 7

Pharmacologic Therapy for Hypertension

• First-line drug therapy for hypertension consists of a thiazide or thiazidelike diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 4
• The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk 4
• Thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers are the preferred medications in nonblack patients 6

Blood Pressure Goals and Outcomes

• Reducing diastolic blood pressure to less than 90 mm Hg is beneficial in adults older than 30 years 6
• A blood pressure goal of less than 140/90 mm Hg is recommended in patients with chronic kidney disease and in those with diabetes mellitus 6
• An SBP reduction of 10 mm Hg decreases risk of CVD events by approximately 20% to 30% 4