Management of Stage 1 Hypertension in Adults

Assessment and Target Blood Pressure

• The International Society of Hypertension guidelines recommend a target blood pressure of <130/80 mmHg for adults, including those with stage 1 hypertension 1
• Home blood pressure readings should be used to confirm inadequate blood pressure control, with target readings of <135/85 mmHg for home measurements 1
• Multiple readings should be used to assess blood pressure control, taking into account the patient's home monitoring range 1

Medication Adjustment and Dosing

• For non-black patients, the recommended approach is to increase the ARB (losartan) to full dose before adding additional agents 1, 2
• Increasing losartan from 50mg to 100mg provides additional blood pressure reduction without significantly increasing adverse effects, as demonstrated in clinical studies 3

Monitoring and Follow-up

• After increasing the losartan dose, blood pressure should be rechecked within 4 weeks 1
• Target blood pressure control should be achieved within 3 months 1, 2
• Home blood pressure monitoring should continue, with regular assessment of blood pressure control 1

Alternative Options and Considerations

• If blood pressure remains uncontrolled after increasing losartan to 100mg, the next step would be to add a thiazide/thiazide-like diuretic 1, 2
• For elderly patients, medication changes should be made gradually to minimize adverse effects, according to the American College of Cardiology 4
• Medication adherence is critical for blood pressure control, so maintaining a stable regimen with once-daily dosing supports adherence 4