Hypertension Guide for Boomers

• High blood pressure levels: normal, less than 120/less than 80 mm Hg; prehypertension, 120-139/80-89 mm Hg; stage 1 hypertension, 140-159/90-99 mm Hg; stage 2 hypertension, at or greater than 160/at or greater than 100 mm Hg.
• Restrict dietary sodium to 1500 mg (65 mmol) per day in adults 50 years of age or younger.
• Perform 30 min to 60 min of moderate aerobic exercise four to seven days per week
• Maintain a healthy body weight (BMI 18.5 kg/m to 24.9 kg/m) and waist circumference (less than 102 cm for men and less than 88 cm for women)
• Limit alcohol consumption
• Emphasizes fruits, vegetables and low-fat dairy products.
• Eat foods rich in dietary and soluble fiber, whole grains and protein from plant sources, and that is low in saturated fat and cholesterol
• Blood pressure should be decreased to less than 140/90 mmHg in all patients, and to less than 130/80 mmHg in patients with diabetes mellitus or chronic kidney disease.
• Initial therapy should include thiazide diuretics, angiotensin- converting enzyme (ACE) inhibitors (in patients who are not black), long-acting calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs) or beta-blockers (in those younger than 60 years of age).
• A combination of two first-line agents may also be considered as initial treatment of hypertension if systolic blood pressure is 20 mmHg above target or if diastolic blood pressure is 10 mmHg above target.
• The combination of ACE inhibitors and ARBs should not be used
• In patients with coronary artery disease, ACE inhibitors, ARBs or beta blockers are recommended as first-line therapy
• In patients with cerebrovascular disease, an ACE inhibitor/diuretic combination is preferred
• In patients with proteinuric nondiabetic chronic kidney disease, ACE inhibitors or ARBs (if intolerant to ACE inhibitors) are recommended
• In patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies.
• In selected high-risk patients in whom combination therapy is being considered, an ACE inhibitor plus a long-acting dihydropyridine CCB is preferable to an ACE inhibitor plus a thiazide diuretic.
• All hypertensive patients with dyslipidemia should receive statin therapy. Once blood pressure is controlled, low-dose acetylsalicylic acid therapy should be considered.

 

References:

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)

Can J Cardiol.The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy.Hackam DG