Pharmacological Interventions
The Joint National Commission JNC8 issued evidence-based guidelines for management of Hypertension (James et al., 2014). The JNC8 recommends 4 pharmacologic classes of medications to manage hypertension. These medications include calcium channel blockers (CCB), thiazide-type diuretics, angiotensin receptor blockers (ARB), and angiotensin-converting enzyme inhibitors (ACEI). Therapeutic blood pressure (BP) goals and first-line medications differ by race, presence of chronic disease, and age (Table 5).
JNC8 proposed three initial treatment strategies based on expert opinion. The specific approach depends on the stage of hypertension assessed for the patient (Fig. 8). For all three strategies, failure to achieve goal BP within 1 month of treatment with the initial medication(s) requires titration of the first medication(s) and/or the addition of a second or third. The efficacy of the therapy should be assessed monthly until the goal BP is achieved. Second and third medications should be selected from the first-line pharmacological classes (Table 5). If BP is not controlled with three medications, additional pharmacological classes or referral to a hypertension specialist may be needed. Concurrent therapy with ACEI and ARB should be avoided.
Lifestyle Interventions
Eat a healthy diet
Follow the Dietary Approaches to Stop Hypertension (DASH) diet.
- Reduce sodium intake to less than 2,400 mg/d
- Increase dietary intake of vegetables, fruits, whole grains, low-fat dairy, poultry, fish, legumes, and nuts.
- Limit sweets and sugar-added beverages.
Maintain a healthy weight
Weight loss reduces systolic and diastolic BP.
Engage in physical activity
Add 3-4, 40 minute sessions of moderate to vigorous physical activity per week.
(Eckel et al., 2013; WHO 2007; Goodpaster et al., 2010; Dansinger, Gleason, Griffith, Selker, & Schaefer 2005)