Elevated Blood Pressure When Lifestyle Modification Has Not Achieved Blood Pressure Targets
This protocol addresses adults with elevated blood pressure who have completed a structured lifestyle modification programme but have not reached their blood pressure goals, and in whom the next clinical step is indicated.
Lifestyle modification — a structured programme addressing diet, body weight, physical activity, alcohol intake, and stress reduction — did not achieve an average SBP <130 mm Hg or average DBP <80 mm Hg.
Adding antihypertensive medication to ongoing lifestyle measures is the recommended next step, with selection from first-line drug classes. The specific choice and number of agents are guided by the degree of blood pressure elevation.
Average SBP of at least <130 mm Hg (with encouragement to achieve <120 mm Hg) and DBP <80 mm Hg, reassessed at monthly intervals until control is achieved.
References
DOI: 10.1161/CIR.0000000000001356
- For adults initiating antihypertensive drug therapy, thiazide-type diuretics, long-acting dihydropyridine CCB, and ACEi or ARB are recommended as first-line therapy to prevent CVD.
- In adults with stage 1 hypertension (SBP 130–139 mm Hg and DBP 80–89 mm Hg), initiation of antihypertensive drug therapy with a single first-line antihypertensive drug is reasonable, with dosage titration and sequential addition of other agents as needed to achieve BP control.
- In adults with stage 2 hypertension (SBP ≥140 mm Hg and DBP ≥90 mm Hg), initiation of antihypertensive drug therapy with 2 first-line agents of different classes, ideally in a single-pill combination (SPC), is recommended to improve BP control and adherence.
- In adults with confirmed hypertension who are at increased risk for CVD, an SBP goal of at least <130 mm Hg, with encouragement to achieve SBP <120 mm Hg, is recommended to reduce the risk of cardiovascular events and total mortality.
- In adults with confirmed hypertension who are at increased risk for CVD, a DBP target of <80 mm Hg is recommended to reduce the risk of cardiovascular events and total mortality.
- Adults with uncontrolled hypertension placed on new or intensified medical therapy should have follow-up evaluations for medication adherence and response to treatment at monthly intervals until control is achieved.