Initial Management of Hypertension

Diagnosis and Assessment

The American Heart Association recommends confirming hypertension diagnosis using validated automated upper arm cuff device with appropriate cuff size, measuring BP in both arms at first visit and using the arm with higher readings for subsequent measurements 2
Hypertension is defined as office BP ≥130/85 mmHg, confirmed with home BP monitoring (≥135/85 mmHg) or 24-hour ambulatory BP monitoring (≥130/80 mmHg), according to the American Heart Association 2, 3
The American College of Cardiology recommends assessing for target organ damage, cardiovascular risk factors, and potential secondary causes of hypertension 2

The American Diabetes Association recommends weight management through caloric restriction for overweight/obese patients with BP >120/80 mmHg 1
The American Heart Association suggests following DASH (Dietary Approaches to Stop Hypertension) eating pattern, including reducing sodium intake (<2,300 mg/day), increasing potassium intake (8-10 servings of fruits and vegetables daily), and consuming low-fat dairy products (2-3 servings daily) 1
The American College of Cardiology recommends at least 150 minutes of moderate-intensity aerobic activity per week for patients with BP >120/80 mmHg 1
The American Heart Association advises alcohol moderation, with no more than 2 servings per day for men and 1 serving per day for women 1
The American College of Cardiology recommends complete smoking cessation for all smokers 1, 4

The American Heart Association recommends starting drug therapy immediately in high-risk patients (with cardiovascular disease, chronic kidney disease, diabetes, target organ damage, or aged 50-80 years) with BP 130/80-149/99 mmHg 2, 3
The American College of Cardiology suggests starting drug therapy immediately along with lifestyle modifications for patients with BP ≥150/90 mmHg 1, 2
The American Heart Association recommends considering initial treatment with two antihypertensive medications for more effective BP control in patients with BP ≥150/90 mmHg 1
The American College of Cardiology recommends first-line drug therapy including ACE inhibitors, angiotensin receptor blockers (ARBs), thiazide-like diuretics, or dihydropyridine calcium channel blockers 1

The American Diabetes Association recommends using ACE inhibitor or ARB as first-line therapy for patients with albuminuria (UACR ≥30 mg/g) 1
The American College of Cardiology suggests using ACE inhibitor or ARB as first-line therapy for patients with established coronary artery disease 1
The American Heart Association recommends considering starting with ARB + dihydropyridine calcium channel blocker or calcium channel blocker + thiazide-like diuretic for Black patients 2, 3
The American College of Cardiology advises considering starting with monotherapy at lower doses for patients >80 years or frail 2

The American Heart Association recommends monitoring BP control with a target of achieving BP goal within 3 months 2, 3
The American College of Cardiology suggests monitoring serum creatinine and potassium 7-14 days after initiation or dose changes for patients on ACE inhibitors, ARBs, or mineralocorticoid receptor antagonists 1
The American Heart Association recommends considering home BP monitoring to guide medication adjustments 4
The American College of Cardiology advises scheduling monthly visits until BP target is achieved 4