From the Guidelines
Treating hypertension effectively requires a combination of lifestyle modifications and possibly medication, with the goal of keeping blood pressure below 130/80 mmHg. To achieve this, patients should start by reducing sodium intake to less than 2,300 mg daily, increasing consumption of fruits, vegetables, and whole grains while limiting processed foods, as recommended by the 2018 standards of medical care in diabetes 1. Regular physical activity—aim for at least 150 minutes of moderate exercise weekly—can lower blood pressure by 5-8 mmHg. Weight loss, if overweight, can significantly reduce blood pressure; losing just 10 pounds may help. Limiting alcohol to no more than one drink daily for women and two for men, and quitting smoking are also crucial.
Some key lifestyle modifications include:
- Weight loss if overweight or obese
- A Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern including reducing sodium and increasing potassium intake
- Moderation of alcohol intake
- Increased physical activity, as outlined in the 2018 standards of medical care in diabetes 1.
For medications, first-line options include:
- 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), as recommended by the 2018 guidelines 1.
It is essential to monitor blood pressure regularly and adjust lifestyle and medication as needed to achieve the target blood pressure, with the goal of preventing complications like heart disease and stroke, as emphasized in the 2018 standards of medical care in diabetes 1. Consistency with both lifestyle changes and medication adherence is crucial for effective hypertension management.
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)
Tips to treat hypertension include:
- Comprehensive cardiovascular risk management
- Lipid control
- Diabetes management
- Antithrombotic therapy
- Smoking cessation
- Exercise
- Limited sodium intake
- Using more than one drug to achieve blood pressure goals, as necessary 2 3
From the Research
Lifestyle Modifications
- Weight loss: Reducing weight can help decrease blood pressure, and studies have shown that overweight individuals are at a higher risk of developing hypertension 4
- Healthy dietary pattern: A diet low in sodium and high in potassium can help lower blood pressure, and the Dietary Approaches to Stop Hypertension (DASH) eating plan is recommended 5, 4
- Physical activity: Regular physical exercise can help lower blood pressure and reduce the risk of cardiovascular disease 6, 4
- Moderation or elimination of alcohol consumption: Reducing alcohol intake can help decrease blood pressure, as excessive alcohol consumption is associated with increased blood pressure 7, 4
- Stress management and adequate sleep patterns: These lifestyle interventions can also help reduce blood pressure and improve overall health 6
Pharmacologic Therapy
- First-line drug therapy: Thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and calcium channel blockers are recommended as first-line treatments for hypertension 7, 8
- Combination therapy: Using a combination of two or more drugs can be more effective than monotherapy in achieving target blood pressure goals, especially for patients with renal disease 8
- Titration of medication: Medication should be titrated according to office and home blood pressure levels to achieve target blood pressure goals 7
Blood Pressure Targets
- Target blood pressure: Less than 130/80 mm Hg for adults under 65 years and less than 130 mm Hg for adults 65 years and older 7
- Importance of blood pressure control: Achieving target blood pressure goals can help reduce the risk of cardiovascular disease and mortality, and only 44% of US adults with hypertension have their blood pressure controlled to less than 140/90 mm Hg 7