Hypertension Management Guidelines

Lifestyle Modifications

The American Heart Association recommends lifestyle interventions, including sodium restriction to <2,300 mg/day, as the foundation of hypertension management 1, 2
A DASH diet pattern, including 8-10 servings of fruits/vegetables daily and 2-3 servings of low-fat dairy products, is recommended for hypertension management 3, 2
Potassium supplementation of 3,500-5,000 mg/day through dietary sources is recommended 3
Elimination of sugar-sweetened beverages and restriction of free sugar to maximum 10% of energy intake is recommended 2
Alcohol moderation, defined as ≤2 drinks/day for men and ≤1 drink/day for women, is recommended 3, 2
Complete tobacco cessation with referral to smoking cessation programs is recommended 2

The European Society of Cardiology recommends initiating pharmacological therapy at BP ≥140/90 mm Hg for most adults 1, 4
For high cardiovascular risk patients, consideration of treatment at lower thresholds based on individualized assessment is recommended 4, 5
The World Health Organization recommends four classes as first-line agents: thiazide or thiazide-like diuretics, ACE inhibitors or ARBs, long-acting dihydropyridine calcium channel blockers, and beta-blockers 1, 2
Most adults require more than one agent to achieve target BP, with an initial two-drug combination of RAS blocker plus either a dihydropyridine calcium channel blocker or thiazide/thiazide-like diuretic recommended 1, 2
Special population considerations, including black patients, diabetes mellitus, chronic kidney disease with proteinuria, and post-stroke/TIA, require tailored pharmacological therapy 2, 3, 4

The American College of Cardiology recommends a target BP of <140/90 mm Hg for all patients without comorbidities 1, 3
A target systolic BP of 120-129 mm Hg is recommended for most adults if well tolerated, based on European guidelines 2
For patients with diabetes or chronic kidney disease, a target BP of <130/80 mm Hg is recommended 3, 2

Achieving target BP within 3 months of initiating or intensifying therapy is recommended 2
Home BP monitoring with proper technique is essential for accurate diagnosis and ongoing management 5
Monitoring renal function and potassium at least annually when using ACE inhibitors, ARBs, or diuretics is recommended 2
Maintaining treatment lifelong, even beyond age 85, if well tolerated, is recommended 2