What are the guidelines for treating hypertension?

From the Guidelines

Hypertension treatment guidelines are clear: patients with hypertension should be treated with lifestyle modifications and pharmacotherapy to achieve a blood pressure of less than 130/80 mmHg 1.

Initial Treatment

• Initial treatment typically involves lifestyle modifications and pharmacotherapy with angiotensin-converting enzyme inhibitors (ACE inhibitors) such as lisinopril 10-40 mg daily or calcium channel blockers (CCBs) like amlodipine 5-10 mg daily 1.
• For patients with more severe hypertension, combination therapy with an ACE inhibitor and a CCB or a diuretic like hydrochlorothiazide 12.5-25 mg daily may be necessary 1.

Treatment Thresholds

• Hypertension is diagnosed when blood pressure is consistently ≥130 and/or ≥80 mm Hg 1.
• Non-high risk individuals will initiate drug therapy when BP is ≥140/90 mm Hg, while high-risk individuals initiate drug therapy when BP ≥ 130/80 mm Hg 1.

Target Blood Pressure

• The target BP is minimally <130/80 mm Hg in most patients, with a systolic target <130 mmHg for those 65 and older 1.

Treatment Duration

• Treatment duration is typically lifelong to maintain blood pressure control and prevent cardiovascular complications 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)

The guidelines for treating hypertension include:

• Comprehensive cardiovascular risk management
• Control of high blood pressure through
  • Lipid control
  • Diabetes management
  • Antithrombotic therapy
  • Smoking cessation
  • Exercise
  • Limited sodium intake
• Many patients may require more than one drug to achieve blood pressure goals
• Following 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

Guidelines for Treating Hypertension

The guidelines for treating hypertension involve a combination of lifestyle modifications and pharmacotherapy.

• Lifestyle modifications are the first-line therapy for hypertension, consisting of:
  • Weight loss
  • Healthy dietary pattern with low sodium and high potassium intake
  • Physical activity
  • Moderation or elimination of alcohol consumption 4, 5
• Pharmacotherapy is initiated based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk.
• First-line drug therapy for hypertension consists of:
  • A thiazide or thiazide-like diuretic
  • An angiotensin-converting enzyme inhibitor or angiotensin receptor blocker
  • A calcium channel blocker 4, 6, 5, 7
• The goal of treatment is to achieve a blood pressure target of <130/80 mm Hg for adults <65 years and <130 mm Hg for adults ≥65 years 4

Combination Therapy

Combination therapy is often required to achieve blood pressure goals, with more than 70% of adults treated for primary hypertension eventually requiring at least two antihypertensive agents 6.

• Four main classes of medications are used in combination therapy:
  • Thiazide diuretics
  • Calcium channel blockers
  • Angiotensin-converting enzyme inhibitors
  • Angiotensin receptor blockers 6, 8
• The choice of combination therapy depends on the patient's individual characteristics, such as the presence of heart failure, chronic kidney disease, or diabetes mellitus 6, 8