Treatment-hypertension

• Every ↓ 5 mmHg → ~10% ↓ ischemic heart disease, stroke, and HF (Lancet 2021;397:1625)
• Lifestyle modifications as Treatment-hypertension (each may ↓ SBP ~5 mmHg) weight loss: goal BMI 18.5–24.9; aerobic exercise: 90–150 min exercise/wk diet: rich in fruits & vegetables, low in saturated & total fat (DASH, NEJM 2001;344:3) limit Na: ideally ≤1.5 g/d or ↓ 1 g/d; ↑ K intake / use salt substitute (NEJM 2021;385:1067) limit alcohol: ≤2 drinks/d in men; ≤1 drink/d in women & lighter-wt Pts; avoid NSAIDs
• ACC/AHA: initiate BP med if BP ≥130/80 & either clinical ASCVD, HF, CKD, T2DM, ≥65 yrs old or 10-y ASCVD risk ≥10%; otherwise if BP ≥140/90
• In high CV risk w/o DM, SBP target <120 (via unattended automated cuff) ↓ MACE & mortality vs. <140 mmHg, but w/ ↑ HoTN, AKI, syncope, electrolyte abnl (NEJM 2021;384:1921 & 385:1268) Pharmacologic options-Treatment-hypertension