From the Guidelines
Hypertension management for Indians should prioritize lifestyle modifications, including reduced salt intake to less than 5g/day, as recommended by the Association of Physicians of India, Cardiological Society of India, Indian College of Physicians, and Hypertension Society of India 1.
Diagnosis and Classification
Hypertension diagnosis and classification are crucial for effective management. Blood pressure is classified as normal (<120/80 mmHg), elevated (120-129/<80 mmHg), stage 1 hypertension (130-139/80-89 mmHg), or stage 2 hypertension (≥140/≥90 mmHg). Diagnosis requires at least two elevated readings on separate occasions.
Lifestyle Modifications
Lifestyle modifications are the cornerstone of treatment for Indians with hypertension. These include:
- Reduced salt intake (limit to <5g/day) as recommended by the Indian guidelines 1
- Adopting a DASH-like diet rich in fruits and vegetables
- Regular physical activity (150 minutes/week)
- Weight reduction
- Limiting alcohol
- Smoking cessation
Medications
First-line medications for Indians with hypertension include:
- Calcium channel blockers (amlodipine 5-10 mg daily)
- ACE inhibitors (ramipril 5-10 mg daily)
- ARBs (telmisartan 40-80 mg daily)
- Thiazide diuretics (hydrochlorothiazide 12.5-25 mg daily) Indians often respond well to calcium channel blockers and may require lower initial doses due to smaller body size.
Treatment Targets
Treatment targets are generally <140/90 mmHg for most adults and <130/80 mmHg for those with diabetes, chronic kidney disease, or cardiovascular disease. Combination therapy is often needed, with fixed-dose combinations improving adherence. Regular monitoring is essential, with home blood pressure monitoring encouraged. Indians have a higher prevalence of salt sensitivity, metabolic syndrome, and earlier onset of hypertension, making aggressive management crucial to prevent complications like stroke, heart failure, and kidney disease, as noted in the 2020 international society of hypertension global hypertension practice guidelines 1.
From the Research
Diagnosis and Classification of Hypertension
- Hypertension is defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg 2
- The diagnosis of hypertension is based on the level of BP and the presence of high atherosclerotic CVD risk 2
Management of Hypertension
- First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 2, 3, 4, 5
- Lifestyle modifications that effectively lower blood pressure are increased physical activity, weight loss, limited alcohol consumption, relaxation techniques, and dietary changes such as low sodium and high potassium intake 2, 4, 5
- When drug therapy is required, first-line therapies are thiazide or thiazidelike diuretics, angiotensin-converting enzyme inhibitor or angiotensin receptor blockers, and calcium channel blockers 2, 6
Culturally Tailored Lifestyle Modification Strategies
- Individual's cultural practices have the potential to determine their diet, physical activity levels, knowledge, and perception about HTN, adherence to treatment and medications, and the use of local herbal preparations for HTN management 3
- It is essential to consider patients' cultural beliefs before recommending lifestyle behaviors for HTN management 3
Non-Pharmacological Management of Hypertension
- Non-pharmacological management of hypertension includes lifestyle modifications, stress reduction, and relaxation techniques such as Yoga, Acupuncture, Tai chi, mindfulness-based stress-reduction program, and Transcendental Meditation 4
- Non-pharmacological methods should be initiated in the early phase of disease and should be continued with medication 4