Guidelines for Managing Hypertension

Diagnosis and Classification

The European Society of Cardiology recommends that for most adults with hypertension, the target blood pressure is ≤140/85 mmHg, while patients with diabetes, renal impairment, or established cardiovascular disease should aim for a lower target of ≤130/80 mmHg 1
Blood pressure should be measured using a validated device with the patient seated, arm at heart level, with at least two measurements at each visit 2
Hypertension is classified as: Normal: <120/80 mmHg, Prehypertension/Elevated: 130-139/80-89 mmHg, Stage 1: 140-159/90-99 mmHg, Stage 2: ≥160/100 mmHg 3
Ambulatory or home blood pressure monitoring should be considered for suspected white coat hypertension, with expected values approximately 10/5 mmHg lower than office readings 4

Urgent treatment is needed for BP ≥180/110 mmHg 4
For BP 140-159/90-99 mmHg, treatment decisions should consider the presence of target organ damage, established cardiovascular disease, diabetes, and 10-year cardiovascular disease risk ≥20% 4
All patients with confirmed BP ≥140/90 mmHg should receive prompt lifestyle measures and pharmacological treatment 1

Lifestyle modifications are recommended for all patients with elevated blood pressure and should complement pharmacological therapy 5, 1
Effective lifestyle interventions include regular physical activity, weight reduction, dietary changes, sodium restriction, alcohol moderation, and smoking cessation 1

First-line drug therapy includes thiazide or thiazide-like diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs) 3, 1
For most patients with confirmed hypertension (BP ≥140/90 mmHg), combination therapy is recommended as initial treatment 1
Preferred combinations include a renin-angiotensin system (RAS) blocker with either a dihydropyridine CCB or diuretic 1

Patients with diabetes, renal impairment, or established cardiovascular disease should aim for a lower target of ≤130/80 mmHg 4
For elderly patients (≥80 years), treatment should be maintained if well tolerated 1

Regular BP monitoring is necessary, with home readings when possible 2
Annual reassessment of cardiovascular risk is recommended 2
Medications should be taken at the most convenient time of day to establish a habitual pattern and improve adherence 1