Hypertension Management Guidelines
Diagnostic and Evaluation
- The European Heart Journal recommends measuring blood pressure at both arms during the first visit and using the arm with the higher values for subsequent measurements 1
- The European Heart Journal suggests screening for secondary causes of hypertension, including measuring renin and aldosterone in all adults with confirmed hypertension (blood pressure ≥140/90 mmHg) to detect primary hyperaldosteronism 2
- The European Heart Journal recommends calculating the 10-year cardiovascular risk using validated tools 1
- Diabetes Care suggests obtaining a fasting lipid profile in all hypertensive patients 3
Lifestyle Modifications
- Diabetes Care recommends that all patients with blood pressure >120/80 mmHg receive lifestyle modification counseling, including adopting a DASH-style diet with 8-10 servings of fruits and vegetables per day and 2-3 servings of low-fat dairy products 4
- Diabetes Care suggests reducing sodium intake to <2,300 mg/day 4
- Praxis Medical Insights recommends cessation of smoking 1
Pharmacological Treatment
- Diabetes Care recommends starting pharmacological treatment with two antihypertensive medications for patients with blood pressure ≥150/90 mmHg 4
- European Heart Journal suggests using a combination of an ACE inhibitor or ARB with a dihydropyridine calcium channel blocker as first-line therapy 5
- Diabetes Care recommends using an ACE inhibitor or ARB as first-line therapy in patients with diabetes 3, 4
- European Heart Journal suggests using a diuretic, such as chlorthalidone or indapamide, in combination with other medications 4, 5
Treatment Escalation
- European Heart Journal recommends escalating treatment to a combination of three medications if blood pressure is not controlled with two medications 5
- Diabetes Care suggests adding spironolactone for patients with resistant hypertension (blood pressure not controlled with three medications, including a diuretic) 3, 5
Target Blood Pressure
- Diabetes Care recommends a target blood pressure of <130/80 mmHg for patients with diabetes 4
- European Heart Journal suggests a target blood pressure of <130/80 mmHg for the general population 7
- International Journal of Stroke recommends a target blood pressure of <140/90 mmHg for patients with non-diabetic chronic kidney disease 6
Follow-up and Monitoring
- Praxis Medical Insights recommends re-evaluating blood pressure within 2-4 weeks after initiating treatment 1
- European Heart Journal suggests monitoring blood pressure annually once control is established 7
- Diabetes Care recommends monitoring serum creatinine and potassium 7-14 days after initiating or changing the dose of an ACE inhibitor, ARB, or mineralocorticoid receptor antagonist 4