From the Guidelines
Management of hypertension for Indians should focus on a combination of lifestyle modifications and medication when necessary, with a goal to reduce morbidity, mortality, and improve quality of life. Indians should aim for a blood pressure target of less than 140/90 mmHg, or lower for those with diabetes or kidney disease, as recommended by various guidelines, including the 2020 international society of hypertension global hypertension practice guidelines 1. First-line medications typically include calcium channel blockers (like amlodipine 5-10 mg daily), ACE inhibitors (such as ramipril 5-10 mg daily), or ARBs (like telmisartan 40-80 mg daily), which are effective in reducing blood pressure and cardiovascular risk, as stated in the 2021 WHO Guidelines for the Pharmacological Treatment of Hypertension in Adults 1. Thiazide diuretics (hydrochlorothiazide 12.5-25 mg daily) are also effective, especially for Indian patients who often have salt-sensitive hypertension, as mentioned in the example answer. Many Indians require combination therapy, with two or more medications at lower doses to minimize side effects. Lifestyle modifications are crucial and include:
- Reducing salt intake to less than 5g daily, as recommended by the Association of Physicians of India, Cardiological Society of India, Indian College of Physicians, and Hypertension Society of India, India in 2019 1
- Adopting a diet rich in fruits and vegetables
- Limiting alcohol
- Maintaining healthy weight
- Exercising regularly (at least 150 minutes weekly)
- Practicing stress management through yoga or meditation Regular monitoring is essential, with home blood pressure monitoring recommended alongside clinical visits, to ensure that the treatment plan is effective in reducing blood pressure and cardiovascular risk. Indians should be particularly vigilant as they have higher rates of hypertension at younger ages and increased risk of complications like stroke and kidney disease compared to Western populations, partly due to genetic factors and higher salt consumption in the traditional diet, as mentioned in the 2020 international society of hypertension global hypertension practice guidelines 1. The use of potassium-enriched salt substitutes may also be beneficial in reducing blood pressure, as suggested by the review of recommendations in clinical management guidelines 1. However, it is essential to consider the individual patient's needs and health status when selecting a treatment plan, and to regularly monitor and adjust the plan as needed to ensure optimal outcomes.
From the Research
Management of Hypertension for Indians
- Hypertension is a major risk factor for cardiovascular diseases, and its management may require both pharmacological and non-pharmacological interventions 2.
- Non-pharmacological interventions, such as lifestyle modifications, can help reduce the daily dose of antihypertensive medication and delay the progression from prehypertension to hypertension stage 2.
- Lifestyle modifications include:
- Dietary modifications, such as adopting the DASH diet or the traditional Mediterranean diet, which promote the consumption of fruits, vegetables, grains, dairy products, and food rich in K+, Mg+2, Ca+2, and phosphorus 2, 3.
- Exercise and weight loss, which are the second major intervention for hypertension management 2, 3.
- Avoiding stressful lifestyle, depression, and anxiety, which can help reduce elevated blood pressure 2, 4.
- Minimizing alcohol consumption, which can also help reduce blood pressure 2, 5.
- Cultural practices and beliefs can influence an individual's diet, physical activity levels, knowledge, and perception about hypertension, adherence to treatment and medications, and the use of local herbal preparations for hypertension management 6.
- It is essential to consider a patient's cultural beliefs before recommending lifestyle behaviors for hypertension management 6.
- Non-pharmacological methods should be initiated in the early phase of the disease and continued with medication 4, 5.
- Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, can help prevent and treat hypertension 3.