This guide is based on American Heart Association and American College of Cardiologists guidelines.
Hypertension is defined by a systolic blood pressure ≥ 140 mm Hg and/or a diastolic blood pressure ≥ 90 mm Hg based on Joint National Commission (JNC) 8 guidelines. The condition increases the risk of cardiovascular disease, stroke, and kidney damage. Management includes lifestyle modifications and, if necessary, medications.
Importantly, daily at-home monitoring is preferred over sporadic in-office measurements as the gold standard for a patient’s baseline blood pressure.
First-line recommendations:
DASH Diet (Dietary Approaches to Stop Hypertension): A heart-healthy diet emphasizing fruits, vegetables, whole grains, lean proteins, and low-fat dairy while reducing sodium intake (<2300 mg/day) and limiting saturated fats and added sugars. The DASH diet is proven to lower blood pressure significantly by 10-20 mm Hg. Recommended DASH diet guide.
Home Blood Pressure Monitoring (HBPM): Regular at-home BP measurements help track treatment effectiveness and provide more reliable data than isolated in-office readings. Use a validated automatic BP cuff; measure twice daily (morning and evening) for optimal monitoring. Recommended FDA-registered device.
Structured exercise: Increased physical activity with a structured exercise program is recommended for adults with elevated BP or hypertension. 90–150 min per week of exercise (aerobic or resistance) can reduce BP by 5 mm Hg.
Reduce alcohol: Adult men and women with elevated BP or hypertension who currently consume alcohol should be advised to drink no more than 2 and 1 standard drinks per day, respectively. This can lower BP by around 4 mm Hg.
Prescription medications:
ACE inhibitors (e.g., lisinopril): Typically first-line for hypertension. Dose: 10-40 mg once daily.
Calcium channel blockers (e.g., amlodipine): Effective for many patients. Dose: 5-10 mg once daily.
Thiazide diuretics (e.g., hydrochlorothiazide): Often used as a first-line or add-on therapy. Dose: 12.5-25 mg once daily.
Citations:
Whelton, P. K., et al. (2017). 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13-e115.=
