Initial Treatment of Hypertension
Published Feb 14, 2018 · S. Taler
The New England Journal of Medicine
27
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3
Influential Citations
Abstract
Initial Treatment of HypertensionThe 2017 ACC–AHA Hypertension Guideline redefines hypertension as a systolic blood pressure of 130 mm Hg or more or a diastolic blood pressure of 80 mm Hg or more and lowers the blood‐pressure target to less than 130/80 mm Hg.This blood‐pressure target is supported by the SPRINT trial, which showed lower hypertension‐associated morbidity and all‐cause mortality with a systolic blood‐pressure target of less than 120 mm Hg than with a target of less than 140 mm Hg; electrolyte abnormalities, syncope, and acute kidney injury were more common in the lower‐target group.The initial assessment should consider coexisting conditions, including cardiovascular disease, diabetes mellitus, chronic kidney disease, and elevated risk of cardiovascular disease, in determining when to start blood‐pressure–lowering medication.Recommended lifestyle modifications include restriction of dietary sodium intake, weight loss if the patient is overweight, exercise, moderation of alcohol intake, and increased consumption of potassium‐rich foods.The initial antihypertensive agent should generally be selected from one of four drug classes shown to reduce cardiovascular events: ACE inhibitors, angiotensin‐receptor blockers, calcium‐channel blockers, and thiazide‐type diuretics.Repeat visits are required to ensure ongoing hypertension control.