Management Overview

The goals of treating chronic hypertension are to reduce cardiovascular morbidity and mortality. Treatment involves both lifestyle modifications and pharmacotherapy to lower blood pressure to goal levels. General principles include confirming the diagnosis through proper blood pressure measurement, identifying any secondary causes, assessing cardiovascular risk, and initiating treatment based on hypertension stage. Lifestyle changes like weight loss, dietary modification, exercise, and moderating alcohol intake help lower blood pressure. For patients with stage 1 hypertension or lower, lifestyle changes may be tried first before starting medications. Patients with stage 2 hypertension or those at high cardiovascular risk usually require pharmacotherapy in addition to lifestyle changes. First-line drug classes include ACE inhibitors/ARBs, calcium channel blockers, thiazide diuretics, and for some patients beta blockers. Most patients require combination therapy with agents that have complementary mechanisms. Self-monitoring of blood pressure is critical for assessing therapeutic response and titrating medications to reach goal blood pressures.