As a cardiovascular pharmacist, you will hear debate about when to start drugs in patients with MILD hypertension, systolic blood pressure (BP) 140 to 159 mmHg or diastolic 90 to 99 mmHg. The latest analysis questions whether BP drugs benefit stage 1 or mild hypertension.
It suggests that only one cardiovascular (CV) event is prevented for every 128 patients with mild hypertension treated for 5 years. But experts say that 5 years is too short to show a difference, especially in low-risk patients. Plus treating mild hypertension is likely to prevent progression to higher BPs, which are associated with more CV events. Continue to follow the hypertension treatment guidelines...
Start with lifestyle, DASH diet, exercise, weight loss, etc. FOR MORE INFORMATION, SEE OUR NOTE, "Lifestyle changes to reduce CARDIOvascular risks". Explain that reducing sodium by 1000 mg/day or about half a teaspoon of salt can modestly lower blood pressure. FOR MORE INFORMATION, SEE OUR NOTE, "Sodium-Restricted Diet".
Go to antihypertensive medications if lifestyle changes aren't enough or sooner if patients have other CV risks, dyslipidemia, diabetes, etc. Use a low-dose thiazide diuretic, ACE inhibitor, ARB, or calcium channel blocker in most cases for initial therapy. Try NOT to use beta-blockers first-line for uncomplicated hypertension. They have less evidence of improving CV outcomes.
Aim for a BP goal of less than 140/90 mmHg in most patients. But be aware of when lower or higher goals can be appropriate. In most diabetes patients, aim for about 130/80 mmHg. In the elderly, it's okay to have a systolic of about 150 mmHg if needed to avoid a diastolic BP less than 60 mmHg.
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REFERENCES
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Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev. 2012 Aug 15;(8):CD006742. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006742.pub2/full Or, https://pubmed.ncbi.nlm.nih.gov/22895954
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure The Seventh Report of the Joint National Committee on Complete Report. [online] Available at: http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf