Management of hypertension

Many guidelines exist for the management of hypertension. Most groups, including the JNC, the American Diabetes Associate (ADA), and the American Heart Association/American Stroke Association (AHA/ASA) recommend lifestyle modification as the first step in managing hypertension.

Lifestyle modifications

JNC 7 recommendations to lower BP and decrease cardiovascular disease risk include the following, with greater results achieved when 2 or more lifestyle modifications are combined:

• Weight loss (range of approximate systolic BP reduction [SBP], 5-20 mm Hg per 10 kg)
• Limit alcohol intake to no more than 1 oz (30 mL) of ethanol per day for men or 0.5 oz (15 mL) of ethanol per day for women and people of lighter weight (range of approximate SBP reduction, 2-4 mm Hg)
• Reduce sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride; range of approximate SBP reduction, 2-8 mm Hg)
• Maintain adequate intake of dietary potassium (approximately 90 mmol/day)
• Maintain adequate intake of dietary calcium and magnesium for general health
• Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health
• Engage in aerobic exercise at least 30 minutes daily for most days (range of approximate SBP reduction, 4-9 mm Hg)

The AHA/ASA recommends a diet that is low in sodium, is high in potassium, and promotes the consumption of fruits, vegetables, and low-fat dairy products for reducing BP and lowering the risk of stroke. Other recommendations include increasing physical activity (30 minutes or more of moderate-intensity activity on a daily basis) and losing weight (for overweight and obese persons).

Treatment Recommendations

The following are drug class recommendations for compelling indications based on various clinical trials:

• Heart failure: Diuretic, beta-blocker, ACE inhibitor/ARB, aldosterone antagonist
• Following myocardial infarction: Beta-blocker, ACE inhibitor
• Diabetes:  ACE inhibitor/ARB
• Chronic kidney disease: ACE inhibitor/ARB

American Society of Hypertension/International Society of Hypertension

Joint guidelines were issued by the American Society of Hypertension and the International Society of Hypertension (ASH/ISH)

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