Perspective:

The following are 10 points to remember from clinical practice guidelines, published by the American Society of Hypertension and the International Society of Hypertension, on the management of hypertension:

1. The risk of cardiovascular events, strokes, and kidney disease is lowest at a blood pressure of approximately 115/75 mm Hg. Above 115/75 mm Hg, for each increase of 20 mm Hg in systolic blood pressure or 10 mm Hg in diastolic blood pressure, the risk of major adverse cardiovascular events doubles.

2. Risk for cardiovascular events is primarily related to an increased systolic blood pressure. After the fifth or sixth decade of life, diastolic blood pressure may actually start to decrease, whereas systolic blood pressure continues to increase throughout life—a phenomenon that reflects progressive stiffening of the arterial circulation.

3. Most major guidelines recommend that hypertension be diagnosed when a person’s systolic blood pressure is >140 mm Hg or diastolic blood pressure is >90 mm Hg, or both, on repeated examination.

4. Approximately 95% of adults with hypertension have primary (or essential) hypertension, for which there is no known cause.

5. For the measurement of blood pressure, arm cuffs and automated electronic devices are preferred. Cuffs that fit in the wrist may be inaccurate.

6. The following concurrent medications may cause hypertension: nonsteroidal anti-inflammatory drugs, some antidepressants, migraine medications, and cold remedies.

7. The treatment goal is typically <140 mm Hg for systolic blood pressure and <90 mm Hg for diastolic blood pressure. A target of <150/90 mm Hg is recommended for individuals 80 years or older.

8. For treatment, most patients will require more than one drug to achieve control. Drugs should generally be initiated with at least half of the maximum dose. New drugs should be added or dosage changes made at approximately 2- to 3-week intervals.

9. Patients with stage 2 hypertension (blood pressure >160/100 mm Hg) generally need treatment with two agents.

10. Drug choice should be influenced by age, ethnicity, and comorbidities (e.g., heart failure, diabetes mellitus, etc.). African-American patients may respond well to treatment with calcium channel antagonists and diuretics.