Hypertension Management Guidelines

Diagnosis and Classification

The International Society of Hypertension recommends diagnosing hypertension when office blood pressure readings are consistently ≥140/90 mmHg, with confirmation using home or ambulatory blood pressure monitoring 1
Validated automated upper arm cuff devices with appropriate cuff size should be used, measuring both arms at first visit and subsequently using the arm with higher readings 1, 2
Home BP readings should be <135/85 mmHg and 24-hour ambulatory BP <130/80 mmHg to be considered normal 2

The International Society of Hypertension guidelines recommend a target blood pressure of <130/80 mmHg for most patients, with lifestyle modifications and drug therapy based on blood pressure levels 1, 2, 3
Weight reduction to achieve ideal body weight through reduced calorie intake is recommended 4
Alcohol moderation (≤2 standard drinks/day for men, ≤1 for women) is advised 4
Immediately start medications in high-risk patients (with cardiovascular disease, chronic kidney disease, diabetes, organ damage, or aged 50-80 years) with BP ≥140/90 mmHg 1, 2
After 3-6 months of lifestyle intervention, start medications in low-moderate risk patients with persistent BP ≥140/90 mmHg 1, 2, 3

For non-black patients, start with low dose ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB) 1, 2
For black patients, start with low dose ARB + dihydropyridine CCB or CCB + thiazide/thiazide-like diuretic 1, 2
Consider spironolactone as fourth-line agent for resistant hypertension 1, 2

For patients with coronary artery disease, target BP <130/80 mmHg (<140/80 in elderly) and use RAS blockers, beta-blockers with or without CCBs 4
For patients with previous stroke, target BP <130/80 mmHg (<140/80 in elderly) and use RAS blockers, CCBs, and diuretics 4
For patients with heart failure, target BP <130/80 mmHg but >120/70 mmHg and use RAS blockers, beta-blockers, and mineralocorticoid receptor antagonists 4
For patients with chronic kidney disease, target BP depends on proteinuria level and use RAS blockers as first-line 4, 5
For patients with diabetes, target BP <130/80 mmHg and prefer RAS inhibitors and CCBs 5

Aim to achieve target BP within 3 months 1, 2
Target BP <130/80 mmHg for most patients, individualized for elderly based on frailty 1, 2, 6
Monitor for medication adherence using objective methods when possible 4
If BP remains uncontrolled, refer to a hypertension specialist 2, 3