Description
Summary of Hypertension Management
1. Lifestyle Modifications (first-line for all patients):
- Diet: The DASH (Dietary Approaches to Stop Hypertension) diet emphasizes fruits, vegetables, whole grains, and low-fat dairy, with reduced saturated fat and sodium.
- Sodium Restriction: Limit to less than 2.3 grams per day.
- Physical Activity: Engage in at least 150 minutes of moderate-intensity exercise per week.
- Alcohol Limitation: For men, up to 2 drinks per day; for women, up to 1 drink per day.
- Weight Reduction: Aim for a BMI within the normal range (18.5–24.9 kg/m²).
2. Pharmacologic Treatment (initiated based on blood pressure readings, presence of comorbidities, and cardiovascular risk):
- First-Line Agents:
- Thiazide Diuretics: Reduce blood pressure by promoting sodium and water excretion.
- ACE Inhibitors (ACEi) or ARBs (Angiotensin II Receptor Blockers): Useful in patients with diabetes, chronic kidney disease, or heart failure due to their renal and cardiac protective effects.
- Calcium Channel Blockers (CCBs): Effective in reducing blood pressure, especially in older adults and African American patients.
- Second-Line or Add-On Therapy:
- Beta-Blockers: Used in patients with heart disease or as additional therapy when first-line agents are insufficient.
- Aldosterone Antagonists (e.g., spironolactone): Effective in resistant hypertension, especially in patients with hyperaldosteronism.
- Combination Therapy: Often required to reach target BP, especially for patients with severe hypertension or high cardiovascular risk.
3. Blood Pressure Targets:
- General target: <130/80 mm Hg for most patients, particularly those with cardiovascular disease, diabetes, or chronic kidney disease.
- Individualized targets may be appropriate based on age, comorbidities, and risk of adverse effects.
4. Management of Resistant Hypertension:
- Confirm adherence to medications and lifestyle changes.
- Use a combination of three or more antihypertensive agents, including a diuretic.
- Consider adding an aldosterone antagonist if blood pressure remains uncontrolled.
5. Hypertensive Crises:
- Hypertensive Urgency: Severe elevation in blood pressure without organ damage. Managed with oral antihypertensives to gradually lower BP over 24–48 hours.
- Hypertensive Emergency: Severe hypertension with acute end-organ damage (e.g., encephalopathy, stroke, myocardial infarction). Requires intravenous antihypertensives and rapid BP reduction.
6. Special Populations:
- Pregnancy: Use safe antihypertensives like methyldopa, labetalol, or nifedipine. Avoid ACE inhibitors and ARBs due to teratogenic risks.
- Elderly: Start with lower doses and titrate slowly, as older patients may have a higher risk of hypotension and medication side effects.
7. Monitoring and Follow-Up:
- Regular follow-up to ensure blood pressure targets are met and monitor for side effects.
- Encourage home blood pressure monitoring to improve adherence and track progress.
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