What Is the First-Line Treatment of Essential Hypertension?

Clinical scenario

This protocol applies to adults with essential hypertension at the initial stage of management — before pharmacological therapy has been introduced. It defines the structured evidence-based approach recommended for all adults at this stage.

Approach

First-line care is built around a comprehensive programme of lifestyle and psychosocial modification applicable to all adults with hypertension. The protocol addresses several specific domains — dietary patterns, sodium intake, potassium, alcohol, physical activity, and stress reduction — with defined targets for each. The complete protocol specifies which modifications apply in which circumstances and what thresholds guide each component.

Clinical goal

Lowering of blood pressure toward a target of <130/80 mm Hg, with reassessment after a 3- to 6-month trial of lifestyle intervention.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/CIR.0000000000001356

In adults who have overweight or obesity, weight loss is recommended with a goal of at least 5% of body weight reduction to prevent or treat elevated BP and hypertension.
In adults with or without hypertension, a heart-healthy eating pattern, such as the DASH eating plan, is recommended to prevent or treat elevated BP and hypertension.
In adults with or without hypertension, reduction of dietary sodium intake is recommended to <2300 mg/d, moving toward an ideal limit of <1500 mg/d to prevent or treat elevated BP and hypertension.
In adults with or without hypertension, increasing physical activity, through a structured exercise program that includes aerobic exercise and/or resistance training, is recommended to prevent or treat elevated BP and hypertension.
In adults with hypertension without clinical CVD and with estimated 10-year CVD risk <7.5% based on PREVENT, initiation of medications to lower BP is recommended if average SBP remains ≥130 mm Hg or average DBP remains ≥80 mm Hg after a 3- to 6-month trial of lifestyle intervention to prevent target organ damage and mitigate further increases in BP.

View source ↗