Antihypertensive Treatment Guidelines

Diagnosis and Treatment Thresholds

The American College of Cardiology recommends diagnosing hypertension at blood pressure ≥140/90 mmHg, with pharmacological treatment recommended at this threshold for most adults 1
For patients with existing cardiovascular disease and systolic blood pressure of 130-139 mmHg, pharmacological treatment is strongly recommended 1
For patients without cardiovascular disease but with high cardiovascular risk, diabetes, or chronic kidney disease, and systolic blood pressure of 130-139 mmHg, pharmacological treatment is conditionally recommended 1

The European Society of Cardiology recommends four major drug classes as first-line options: thiazide and thiazide-like diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and long-acting dihydropyridine calcium channel blockers 2
The American Heart Association recommends long-acting dihydropyridine calcium channel blockers as a first-line option 1

The European Society of Cardiology recommends the following two-drug combinations as effective and well-tolerated: thiazide diuretic + ACE inhibitor, thiazide diuretic + ARB, calcium antagonist + ACE inhibitor, and calcium antagonist + ARB 2

The American Heart Association recommends sodium restriction to <1500 mg/day or reduction of at least 1000 mg/day, increased potassium intake (3500-5000 mg/day), weight loss for overweight/obese patients, physical activity (aerobic or dynamic resistance 90-150 min/week), moderation of alcohol intake (≤2 drinks per day in men, ≤1 per day in women), and a DASH-like diet rich in fruits, vegetables, whole grains, and low-fat dairy products 4

The American College of Cardiology recommends a target blood pressure goal of <140/90 mmHg for most patients with hypertension without comorbidities 1
For patients with known cardiovascular disease, a target systolic blood pressure goal of <130 mmHg is strongly recommended 1
For high-risk patients (those with high cardiovascular risk, diabetes mellitus, chronic kidney disease), a target systolic blood pressure goal of <130 mmHg is conditionally recommended 1