CME credit available from Harvard Medical School through July 2021.
The goal of this program is to update prescribers on the most recent evidence and guidelines regarding the treatment of hypertension, emphasizing the importance of accurate blood pressure monitoring to inform management decisions.
Hypertension is common with over 1 in 3 Americans receiving this diagnosis. While 76% of hypertensive patients are being treated, only 54% of these patients are controlled.1 Controlling blood pressure is a critical step to prevent stroke, coronary heart disease, heart failure, and cardiovascular death.2
The first and most important step in identifying and managing hypertension is obtaining accurate blood pressure measurements. All staff should be educated on best-practices for taking a blood pressure. For a quick office card on key steps see Blood Pressure (BP) Card. Simple steps such as rechecking a blood pressure can have an impact on treatment decisions.
The median effect of rechecking a BP (a drop of 8 mm Hg) is equivalent to the impact of starting one new hypertensive medication. In patients with an initial SBP of 140-159 mm Hg, about 50% of patients had an SBP <140 mm Hg when repeated.3 For some patients, taking their blood pressure at home will be an important component of diagnosis and management, especially in cases of suspected white coat hypertension. See the Patient resources section below for information about taking an accurate home blood pressure.
New, lower BP definitions were released in 2017 by the American College of Cardiology and the American Heart Association (ACC/AHA) in collaboration with a host of other professional societies, the first update to blood pressure guideline in over a decade.4
These lower definitions for hypertension and elevated BP place even more importance on the accuracy of BP measurements. The guidelines also outlined management decisions based on initial BP at diagnosis, incorporating cardiovascular risk into treatment decisions for patients with hypertension stage 1.
The SBP goal for all patients being treated for hypertension is 130 mm Hg, with a diastolic goal of <80 mm Hg in adults <60 years old.
In treating to the goal of 130/80 mm Hg, the benefits outweigh the risk.5
Non-drug treatment is the backbone of therapy such as dietary salt reduction, exercise, weight loss, and a heart healthy diet. See the Patient Resources section at the bottom of the page for information about the Dietary Approaches to Stop Hypertension (DASH) diet and salt reduction.
Achieving the blood pressure target is more important than the drug class used to get there.6
When selecting an anti-hypertensive medication, begin with a thiazide-type diuretic, angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), or a calcium channel blocker (CCB). When dual therapy is required, the combination of an ACEI + CCB prevented more CV events than an ACEI + thiazide.7 The algorithm below suggests a strategy for managing therapy, continually reassessing treatment effect to achieve the blood pressure goal.
Information current at time of publication, July 2018.
The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating physician based on the individual patient’s clinical condition.