management of hypertension in adults

Management of hypertension in adult patients involves lifestyle interventions and, when appropriate, antihypertensive drug treatment.

• Offer lifestyle advice to all people with suspected or diagnosed hypertension, and continue to offer it periodically, including advice on diet, exercise, weight loss if overweight, reducing caffeine and dietary sodium intake, smoking cessation, and alcohol reduction ¹.
• For adults with persistent stage 2 hypertension (clinic blood pressure of 160/100 mmHg or higher but less than 180/120 mmHg), offer antihypertensive drug treatment in addition to lifestyle advice, regardless of age ¹.
• For adults with stage 1 hypertension (clinic blood pressure from 140/90 mmHg to 159/99 mmHg), discuss starting antihypertensive drug treatment if they have target organ damage, established cardiovascular disease, renal disease, diabetes, or an estimated 10-year CVD risk of 10% or more; consider treatment if aged under 60 with a risk below 10%; and consider treatment for those over 80 with BP over 150/90 mmHg, using clinical judgment ¹.
• Monitor blood pressure response to lifestyle changes or drug treatment regularly, aiming for a clinic BP below 140/90 mmHg in those under 80, and below 150/90 mmHg in those 80 and over, with adjustments based on individual circumstances ¹.
• Use ABPM or HBPM to monitor treatment response, aiming for average levels below 135/85 mmHg in under 80s and below 145/85 mmHg in 80 and over, considering clinical judgment for frailty or multimorbidity ¹,².
• Review treatment annually, including blood pressure, symptoms, lifestyle, and medication adherence ¹.

In resistant hypertension, seek specialist advice if blood pressure remains uncontrolled despite optimal tolerated doses of four drugs ¹.