From the Guidelines
To approach high blood pressure effectively, start by making lifestyle modifications including adopting the DASH diet, reducing sodium intake to less than 2,300 mg daily, exercising regularly for 150 minutes per week, limiting alcohol consumption, maintaining a healthy weight, and quitting smoking, as recommended by the most recent guidelines 1.
Key Lifestyle Modifications
- Adopting the DASH diet, which is rich in fruits, vegetables, whole grains, and low-fat dairy products
- Reducing sodium intake to less than 2,300 mg daily
- Exercising regularly for at least 150 minutes per week
- Limiting alcohol consumption to no more than 2 servings per day in men and no more than 1 serving per day in women
- Maintaining a healthy weight through caloric restriction and increased physical activity
- Quitting smoking to reduce cardiovascular risk
Medication Therapy
If lifestyle changes are not sufficient, medication therapy may be necessary. Common first-line medications include:
- Thiazide diuretics, such as hydrochlorothiazide 12.5-25 mg daily
- ACE inhibitors, such as lisinopril 10-40 mg daily
- ARBs, such as losartan 25-100 mg daily
- Calcium channel blockers, such as amlodipine 5-10 mg daily
Treatment Goals and Monitoring
Treatment goals typically aim for blood pressure below 130/80 mmHg for most adults 1. Regular home blood pressure monitoring is essential, using a validated upper-arm cuff device and taking readings at the same time daily. Record these measurements to share with your healthcare provider during follow-up visits, which should occur every 3-6 months until blood pressure is controlled.
Importance of Managing Hypertension
High blood pressure requires attention because it silently damages blood vessels and organs over time, increasing risk for heart attacks, strokes, kidney disease, and other complications. The combination of consistent lifestyle changes and medication adherence, when prescribed, provides the best approach to managing hypertension and preventing its serious consequences, as supported by recent guidelines 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 approach high blood pressure, comprehensive cardiovascular risk management is necessary. This includes:
- 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, published guidelines such as those from the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) should be consulted 2 3.
From the Research
Approaching High Blood Pressure
To approach high blood pressure, several lifestyle modifications and medical interventions can be considered.
- Lifestyle modifications are associated with improvements in blood pressure, including the Dietary Approaches to Stop Hypertension diet, sodium restriction, regular exercise, and moderate weight loss 4.
- Reducing diastolic blood pressure to less than 90 mm Hg is beneficial in adults older than 30 years, while reducing systolic blood pressure to less than 150 mm Hg is recommended in adults older than 60 years 4.
- For patients with chronic kidney disease, a blood pressure goal of less than 140/90 mm Hg is recommended, as well as for those with diabetes mellitus 4.
Lifestyle Modifications
Lifestyle modifications can help prevent and control hypertension.
- Maintaining a healthy body weight, moderating consumption of alcohol, exercising, reducing sodium intake, altering intake of calcium, magnesium, and potassium, and reducing stress can help prevent hypertension 5.
- Weight loss, regular exercise, and low alcohol consumption can reduce blood pressure in normotensive and hypertensive individuals 5.
- Sodium restriction and stress management can also reduce blood pressure in hypertensive patients 5.
Medical Interventions
Medical interventions, such as medications, can also be used to treat high blood pressure.
- Thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers are preferred medications in nonblack patients, while thiazide diuretics and calcium channel blockers are preferred in black patients 4.
- Pharmacists can play a role in managing medications and lifestyle behaviors for patients with hypertension 6.
Physical Activity
Physical activity is a critical component of first-line treatment for elevated blood pressure or cholesterol.
- Increasing physical activity has extensive benefits, including improving both blood pressure and blood cholesterol, and is comparable, superior, or complementary to other healthy lifestyle changes 7.
- Physical activity assessment and prescription are an excellent lifestyle behavior treatment option for all patients, including those with mild-moderate-risk blood pressure and cholesterol 7.
Lifestyle Interventions
Lifestyle interventions, including regular physical exercise, body weight management, and healthy dietary patterns, can help prevent and treat hypertension.
- These interventions have physiological mechanisms underlying their beneficial effects on hypertension, including improvements in vascular health and reduced sympathetic overactivation 8.
- Other lifestyle interventions, such as stress management and promotion of adequate sleep patterns, can also have beneficial effects on hypertension 8.