From the Guidelines
For a blood pressure of 157/90, immediate lifestyle interventions and consideration of drug treatment are recommended, as this falls into the category of Grade 2 Hypertension, according to the 2020 international society of hypertension global hypertension practice guidelines 1.
Treatment Approach
The approach to treating a blood pressure of 157/90 involves both lifestyle modifications and potential medication, prioritizing the reduction of morbidity, mortality, and improvement of quality of life.
- Lifestyle interventions should include reducing sodium intake to less than 2,300 mg daily,
- Increasing physical activity to 150 minutes of moderate exercise weekly,
- Maintaining a healthy weight,
- Limiting alcohol consumption, and
- Following the DASH diet rich in fruits, vegetables, and whole grains.
Medication Options
Medication options, as suggested by guidelines such as those from the American College of Cardiology/American Heart Association 1, include:
- Thiazide diuretics (like hydrochlorothiazide 12.5-25 mg daily),
- ACE inhibitors (such as lisinopril 10-20 mg daily),
- ARBs (like losartan 50-100 mg daily), or
- Calcium channel blockers (amlodipine 5-10 mg daily).
Treatment Initiation and Monitoring
Treatment usually begins with a single medication, with dosage adjustments or additional medications added if blood pressure remains above 130/80 after 1-3 months. Regular monitoring is essential, ideally aiming for a target below 130/80 mmHg. These medications work by either reducing fluid volume, relaxing blood vessels, or decreasing heart workload, all of which help lower blood pressure and reduce the risk of heart disease, stroke, and kidney damage. Given the blood pressure of 157/90, initiating lifestyle modifications and considering the start of drug treatment immediately, as per the guidelines 1, is crucial for managing hypertension effectively and reducing the risk of associated complications.
From the FDA Drug Label
The usual starting dose of losartan is 50 mg once daily. The dosage can be increased to a maximum dose of 100 mg once daily as needed to control blood pressure [see CLINICAL STUDIES (14.1)]. Losartan is indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older, to lower blood pressure. The antihypertensive effect of losartan was studied in one trial enrolling 177 hypertensive pediatric patients aged 6 to 16 years old. The sitting diastolic blood pressure (SiDBP) on entry into the study was higher than the 95th percentile level for the patient’s age, gender, and height. At the end of three weeks, losartan reduced systolic and diastolic blood pressure, measured at trough, in a dose-dependent manner
For a blood pressure of 157/90, losartan can be considered as a treatment option.
- The starting dose of losartan is 50 mg once daily.
- The dosage can be increased to a maximum dose of 100 mg once daily as needed to control blood pressure 2. It is essential to monitor the patient's blood pressure response to the medication and adjust the dosage accordingly.
- Losartan has been shown to be effective in reducing systolic and diastolic blood pressure in a dose-dependent manner 2. However, it is crucial to consider the patient's overall health and medical history before initiating treatment with losartan.
- Losartan is indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older 2.
From the Research
Treatment Options for Blood Pressure 157/90
- The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to be effective in reducing blood pressure in adults with and without hypertension 3.
- The DASH diet reduced both systolic and diastolic blood pressure, with a mean reduction of -3.2 mmHg and -2.5 mmHg, respectively 3.
- The modified DASH diet has also been found to be effective in reducing blood pressure, with a mean reduction of -3.26 mmHg in systolic blood pressure and -2.07 mmHg in diastolic blood pressure 4.
Medication Options
- Angiotensin-receptor blockers (ARBs) have been found to be effective in improving left ventricular relaxation in patients with hypertension and diastolic dysfunction, when combined with either hydrochlorothiazide (HCTZ) or a calcium-channel blocker (CCB) 5.
- ACE inhibitors or ARBs are recommended as first-line antihypertensive therapy in the presence of albuminuria, but their utilization has not substantially changed over time, with an estimated 1.6 million adults with albuminuria not receiving ACE inhibitor/ARB therapy 6.