How should I manage a patient with stage 1 hypertension who has no other cardiovascular risk factors?

For a patient with stage 1 hypertension (clinic blood pressure 140/90 mmHg to 159/99 mmHg and subsequent ambulatory or home blood pressure averages within the corresponding range) who has no other cardiovascular risk factors, the initial management should focus on offering lifestyle advice to support blood pressure reduction. This includes guidance on a healthy diet, regular exercise, weight loss if overweight, reducing excessive alcohol intake, limiting caffeine, lowering dietary sodium intake, and smoking cessation support. Continue to offer lifestyle advice periodically regardless of treatment choice.

Antihypertensive drug treatment is generally not routinely offered to people with stage 1 hypertension who do not have target organ damage, established cardiovascular disease, renal disease, diabetes, or an estimated 10-year cardiovascular disease risk of 10% or more. However, for adults under 60 years with stage 1 hypertension and a 10-year CVD risk below 10%, antihypertensive treatment may be considered after discussing the potential benefits and risks, bearing in mind that 10-year risk may underestimate lifetime risk.

Shared decision-making is important: discuss the individual’s cardiovascular risk, preferences, and the risks and benefits of starting antihypertensive medication. Whether or not drug treatment is started, continue to support lifestyle changes and monitor blood pressure regularly.