Initial Treatment for New Onset Hypertension

Lifestyle Modifications and Pharmacologic Therapy

The American Heart Association recommends lifestyle modifications as the foundation of hypertension treatment, including sodium restriction to <1500 mg/day, increased potassium intake, weight loss, regular physical activity, and moderation of alcohol intake 3
The initial treatment for new onset hypertension should begin with lifestyle modifications, followed by pharmacologic therapy with a thiazide/thiazide-like diuretic, ACE inhibitor/ARB, or calcium channel blocker if blood pressure goals are not achieved or if the patient has high cardiovascular risk 1

The American College of Cardiology recommends initiating pharmacologic therapy immediately in high-risk patients with CVD, chronic kidney disease, diabetes, or evidence of organ damage 1
For patients with stage 1 hypertension and 10-year ASCVD risk ≥10%, the European Society of Cardiology recommends initiating pharmacologic therapy 3
Thiazide or thiazide-like diuretics, ACE inhibitors, ARBs, and dihydropyridine calcium channel blockers are recommended as first-line agents for the treatment of hypertension 1

For Black patients, the International Society on Hypertension in Blacks recommends starting with an ARB + calcium channel blocker or calcium channel blocker + thiazide-like diuretic 1
For patients with chronic kidney disease, the National Kidney Foundation recommends using an ACE inhibitor or ARB 3

The American Heart Association recommends monitoring serum creatinine and potassium levels when using ACE inhibitors, ARBs, or mineralocorticoid receptor antagonists 2
The target blood pressure goal is typically <130/80 mmHg for most adults 1