Hypertension | Guidelines and Management

Guidelines for hypertension management

There are many guidelines for hypertension management, but we will discuss the most used ones. The guidelines of the Joint national committee (JNC 7), and the American Diabetes Association (ADA) are the most used.

Joint national committee (JNC 7) recommended the following guidelines:

    • Treatment of hypertension aims to reduce the risk of cardiovascular, renal, and cerebral complications, which may be fatal.
    • People in the prehypertension stage (between 120/80 mmHg and139/89 mmHg) should follow a healthy lifestyle to avoid a further increase in blood pressure and reduce the risk of cardiovascular complications.
    • Thiazide diuretics are the first-line treatment for hypertensive patients without complications. Treating doctors can use it alone or combined with other antihypertensive medications.
    • For patients with a high risk of complications, we should use stronger classes of antihypertensive medications like calcium channel blockers, beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers.
    • For patients with diabetes or kidney disease, we should use two or more antihypertensive drugs.
    • Regardless of the number of used antihypertensive drugs, one of them should be thiazide diuretic.

American Diabetes Association (ADA) guidelines (2017):

    • It’s better to reduce blood pressure to less than 130/80 mmHg with a healthy lifestyle only if you can do it.
    • If blood pressure becomes higher than 140/90 mmHg, we should add a pharmacologic treatment to the lifestyle plan.
    • We can use several classes of antihypertensive drugs: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide diuretics.
    • The first-line treatment for diabetic patients is the angiotensin-converting enzyme inhibitors or angiotensin receptor blockers; the doctor chooses the drug that the patient can tolerate.

♦ The most critical component of the treatment plan is the adherence to it. Thus, the patients must be compliant with their treatment plan to avoid complications.

Lifestyle modification has great benefits for hypertensive patients. Thus, we will discuss some recommendations issued by Joint national committee (JNC 7) and American heart association (AHA):

    • Weight reduction lowers the risk of hypertension; each 10 kg loss reduces blood pressure by 5-10 mmHg.
    • The diet should contain less sodium and fats, more potassium, calcium, and magnesium, and should be rich in fruits and vegetables.
    • Physical exercise for at least 30 minutes per day lowers the risk of hypertension and its cardiovascular complications; it can lower blood pressure by 4-9 mmHg.
    • Reduction of alcohol intake to less than 30mg ethanol for men and 15mg ethanol for women reduces blood pressure by 2-4 mmHg.
    • 30mg ethanol= 720ml of beer, 60ml of 100-proof whiskey, or 300ml of wine.
    • Cessation of smoking has remarkable benefits for hypertensive patients; it reduces the risk of cardiovascular complications.

» Now, we will discuss the guidelines for cases of hypertensive emergencies, issued by the American College of Emergency Physicians (ACEP) in 2013, and the American College of Cardiology/American Heart Association (ACC/AHA) in 2017.