Hypertension Management Guidelines

Diagnosis and Assessment

The European Society of Cardiology recommends blood pressure should be measured using validated devices with patients seated, arm at heart level, with at least two measurements at each visit 2
The American Heart Association recommends ambulatory or home blood pressure monitoring for unusual BP variability, suspected white coat hypertension, or resistant hypertension 3
Initial evaluation should include urinalysis for blood and protein, blood electrolytes and creatinine, blood glucose and lipid profile, and 12-lead ECG, as recommended by the European Society of Cardiology 2, 4
Formal cardiovascular risk assessment should guide treatment decisions, according to the American College of Cardiology 2

The American Heart Association recommends a DASH diet, rich in fruits, vegetables, whole grains, low-fat dairy products, with reduced saturated and total fat content, which lowers SBP by 5-8 mmHg 3, 1
The European Society of Cardiology recommends weight reduction, aiming for BMI 20-25 kg/m² and healthy waist circumference, with approximately 1 mmHg SBP reduction per 1 kg weight loss 3, 1
The American College of Cardiology recommends sodium restriction, limiting to <2,300 mg/day, which lowers SBP by 2-8 mmHg 3, 5
The European Society of Cardiology recommends physical activity, with 150+ minutes/week of moderate aerobic activity, plus resistance training 2-3 times/week, which lowers SBP by 4-9 mmHg 3, 1
The American Heart Association recommends alcohol moderation, limiting to ≤2 drinks/day for men and ≤1 drink/day for women, which lowers SBP by 2-4 mmHg 3, 5

The European Society of Cardiology recommends immediate treatment for BP ≥140/90 mmHg regardless of cardiovascular risk, and BP ≥130/80 mmHg with high cardiovascular risk 1, 6
The American College of Cardiology recommends combination therapy as initial therapy for most patients with confirmed hypertension, with preferred combinations including ACE inhibitor or ARB + dihydropyridine calcium channel blocker, or ACE inhibitor or ARB + thiazide/thiazide-like diuretic 1
The European Society of Cardiology recommends single-pill fixed-dose combinations to improve adherence, and progressing to triple therapy with ACE inhibitor/ARB + calcium channel blocker + thiazide/thiazide-like diuretic for patients not at target with dual therapy 1

The American College of Cardiology recommends a general target of 120-129 mmHg systolic and <80 mmHg diastolic for most adults, with lower targets (<130/80 mmHg) for patients with diabetes, chronic kidney disease, or established cardiovascular disease 1, 6

The American Heart Association recommends team-based care as the most effective approach for achieving BP control, with home BP monitoring and telemonitoring facilitating medication titration and maintenance of BP goals 7
The European Society of Cardiology recommends monthly follow-up visits until BP target is achieved, and 90-day medication refills rather than 30-day when possible 3

The American Heart Association reports a 35-40% reduction in stroke incidence, 20-25% reduction in myocardial infarction, and 50% reduction in heart failure with effective BP control 5
The European Society of Cardiology notes that for every 12 mmHg reduction in SBP maintained over 10 years, one death is prevented for every 11 treated patients with additional cardiovascular risk factors 5