Hypertension

2026-04-23T14:37:46Z

Modified the treatment section in line with the 2025 AHA/ACC guidelines for the management of hypertension

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	__NOTOC__		__NOTOC__
	{{SI}}		{{SI}}
	{{CMG}}; {{AE}} {{Sara.Zand}} {{USAMA}}		{{CMG}}; {{AE}} {{Sara.Zand}} {{USAMA}} {{HMA}}

	{{SK}} Blood pressure; hypertension; high blood pressure; systolic blood pressure; essential hypertension		{{SK}} Blood pressure; hypertension; high blood pressure; systolic blood pressure; essential hypertension
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	:*[[Renin-angiotensin-convertng enzyme inhibitors]] ([[ACEI]] or [[ARB]])		:*[[Renin-angiotensin-convertng enzyme inhibitors]] ([[ACEI]] or [[ARB]])
	:*[[Thiazide-like diuretic]]		:*[[Thiazide-like diuretic]]
	::*~~[[Betablocker]] is~~ first line ~~therapy in the presence of~~ [[~~angina~~]] ~~and [[~~heart failure]].		::*Beta-blockers are not first-line for hypertension unless specific comorbidities (e.g., [[coronary heart disease]], heart failure with reduced ejection fraction) are present.
	::*Second-line lowering [[BP]] agents are used in resistant [[hypertension]] or specific conditions.		::*Second-line lowering [[BP]] agents are used in resistant [[hypertension]] or specific conditions

			* For Stage 2 hypertension (BP ≥140/90 mm Hg), initiation of antihypertensive therapy with two first-line agents of different classes, ideally in a single-pill combination, is recommended to improve blood pressure control and medication adherence.

	*The mainstay of therapy for [[resistant hypertension]] is:		*The mainstay of therapy for [[resistant hypertension]] is:
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	:*Improving medications adherence		:*Improving medications adherence
	:*Diagnosis and treatment of the causes of [[secondary hypertension]]		:*Diagnosis and treatment of the causes of [[secondary hypertension]]
	:*Adding [[spironolactone]] or [[hydralazine]] or [[ minoxidil]] to first line therapy ([[CCB]]s, [[inhibitors of RAS]], [[chlorthalidone]].		:*Adding [[spironolactone]] or [[hydralazine]] or [[ minoxidil]] to first line therapy ([[CCB]]s, [[inhibitors of RAS]], [[chlorthalidone]]).
			:*Renal Denervation may be reasonable as an adjunct in select patients

	{{familytree/start}}		{{familytree/start}}
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	{{familytree \| B01 \| \| \| B02 \| \| \| \| \| B03 \| \| \| \|B04\| \|B01=Nomal [[BP]] ([[BP]]<120/80 mmHg)\|B02=Elevated [[BP]] ([[BP]]120-129/<80mmHg)\|B03=Stage1 [[hypertension]](BP 130-139/80-89mmHg\|B04=Stage 2 [[hypertension]] ([[BP]]≥ 140/90}}		{{familytree \| B01 \| \| \| B02 \| \| \| \| \| B03 \| \| \| \|B04\| \|B01=Nomal [[BP]] ([[BP]]<120/80 mmHg)\|B02=Elevated [[BP]] ([[BP]]120-129/<80mmHg)\|B03=Stage1 [[hypertension]](BP 130-139/80-89mmHg\|B04=Stage 2 [[hypertension]] ([[BP]]≥ 140/90}}
	{{familytree \| \|!\| \| \| \| \|!\| \| \| \| \| \| \|!\| \| \| \| \|!\| }}		{{familytree \| \|!\| \| \| \| \|!\| \| \| \| \| \| \|!\| \| \| \| \|!\| }}
	{{familytree \| C01 \| \| \| C02 \| \| \| \| \| C03 \| \| \| \|C04\| \|C01=Life style modifications\|C02=Nonpharmocological therapy (class1)\|C03= 10 ~~years~~ cardiovascular disease ([[CVD]]) ~~risk≥ 10~~%\|C04=Non pharmacological therapy and [[BP]]lowering medication}}		{{familytree \| C01 \| \| \| C02 \| \| \| \| \| C03 \| \| \| \|C04\| \|C01=Life style modifications\|C02=Nonpharmocological therapy (class1)\|C03= 10-year cardiovascular disease (CVD) risk ≥7.5% by PREVENT\|C04=Non pharmacological therapy and [[BP]]lowering medication}}
	{{familytree \| \|!\| \| \| \| \|!\| \| \| \| \|,\|-\|^\|-\|.\| \| \|!\| \| \| \| \| \| \| \| \|}}		{{familytree \| \|!\| \| \| \| \|!\| \| \| \| \|,\|-\|^\|-\|.\| \| \|!\| \| \| \| \| \| \| \| \|}}
	{{familytree \| \|D01\| \| \| D02 \| \| \| D03 \| \| D04 \|!\| \| \| \| \| \| \| D01=Reevaulation in 1 year (class 2a)\|D02=Reevaulation in 3-6 months (class 1)\|D03= NO, nonpharmocological therapy (class1)\|D04= Yes,non pharmacological therapy and [[BP]] lowering medication}}		{{familytree \| \|D01\| \| \| D02 \| \| \| D03 \| \| D04 \|!\| \| \| \| \| \| \| D01=Reevaulation in 1 year (class 2a)\|D02=Reevaulation in 3-6 months (class 1)\|D03= NO, nonpharmocological therapy (class1)\|D04= Yes,non pharmacological therapy and [[BP]] lowering medication}}
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	*[[Surgery\|Surgical]] procedure may be performed for patients with [[secondary hypertension]] such as [[coarctation of aorta]], [[Primary aldosteronism\|primary aldosteronism.]]		*[[Surgery\|Surgical]] procedure may be performed for patients with [[secondary hypertension]] such as [[coarctation of aorta]], [[Primary aldosteronism\|primary aldosteronism.]]
			*Renal Denervation may be reasonable as an adjunct in select patients with resistant hypertension or drug intolerance, but requires evaluation by a multidisciplinary team.

	===Prevention===		===Prevention===
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	*Effective measures for the [[primary prevention]] of hypertension include: <ref name="WheltonCarey2018">{{cite journal\|last1=Whelton\|first1=Paul K.\|last2=Carey\|first2=Robert M.\|last3=Aronow\|first3=Wilbert S.\|last4=Casey\|first4=Donald E.\|last5=Collins\|first5=Karen J.\|last6=Dennison Himmelfarb\|first6=Cheryl\|last7=DePalma\|first7=Sondra M.\|last8=Gidding\|first8=Samuel\|last9=Jamerson\|first9=Kenneth A.\|last10=Jones\|first10=Daniel W.\|last11=MacLaughlin\|first11=Eric J.\|last12=Muntner\|first12=Paul\|last13=Ovbiagele\|first13=Bruce\|last14=Smith\|first14=Sidney C.\|last15=Spencer\|first15=Crystal C.\|last16=Stafford\|first16=Randall S.\|last17=Taler\|first17=Sandra J.\|last18=Thomas\|first18=Randal J.\|last19=Williams\|first19=Kim A.\|last20=Williamson\|first20=Jeff D.\|last21=Wright\|first21=Jackson T.\|title=2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines\|journal=Hypertension\|volume=71\|issue=6\|year=2018\|issn=0194-911X\|doi=10.1161/HYP.0000000000000065}}</ref>		*Effective measures for the [[primary prevention]] of hypertension include: <ref name="WheltonCarey2018">{{cite journal\|last1=Whelton\|first1=Paul K.\|last2=Carey\|first2=Robert M.\|last3=Aronow\|first3=Wilbert S.\|last4=Casey\|first4=Donald E.\|last5=Collins\|first5=Karen J.\|last6=Dennison Himmelfarb\|first6=Cheryl\|last7=DePalma\|first7=Sondra M.\|last8=Gidding\|first8=Samuel\|last9=Jamerson\|first9=Kenneth A.\|last10=Jones\|first10=Daniel W.\|last11=MacLaughlin\|first11=Eric J.\|last12=Muntner\|first12=Paul\|last13=Ovbiagele\|first13=Bruce\|last14=Smith\|first14=Sidney C.\|last15=Spencer\|first15=Crystal C.\|last16=Stafford\|first16=Randall S.\|last17=Taler\|first17=Sandra J.\|last18=Thomas\|first18=Randal J.\|last19=Williams\|first19=Kim A.\|last20=Williamson\|first20=Jeff D.\|last21=Wright\|first21=Jackson T.\|title=2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines\|journal=Hypertension\|volume=71\|issue=6\|year=2018\|issn=0194-911X\|doi=10.1161/HYP.0000000000000065}}</ref>

	:*[[Weight loss]]: ~~Reduction 1 mmHg~~ in ~~[[blood pressure]] for every one kilogram [[~~weight reduction]]		:*Weight loss: Sustained ≥5% reduction in body weight or ≥3 kg/m² reduction in BMI. Expect ~1 mmHg SBP drop per 1 kg lost
	:*[[Healthy diet]]: A [[diet]] rich in [[fruits]], [[vegetables]], [[whole grains]], [[low-fat dairy products]], reduced content of saturated and [[total fat]]		:*[[Healthy diet]]: A [[diet]] rich in [[fruits]], [[vegetables]], [[whole grains]], [[low-fat dairy products]], reduced content of saturated and [[total fat]]
	:*[[Reduced]] intake of dietary [[sodium]]: ~~Less than 1000-15000~~ mg/day		:*Reduced intake of dietary sodium: Target <2300 mg/day, with ideal limit <1500 mg/day
	:*Enhanced intake of [[dietary~~]][[~~ potassium]]:3500–5000 mg/d by intaking rich diet with [[~~potassium~~]]		:*Enhanced intake of dietary potassium: 3500–5000 mg/d by ideally intaking rich diet with potassium, or moderate supplementation (<80 mmol/day)
			:*Use of salt substitutes: Replace regular table/cooking salt with potassium-based salt substitutes. Avoid in [[CKD]] or with potassium-sparing drugs
			:*Reduced alcohol intake: Abstinence is optimal for BP control. If consumed, reduce intake by >50% to ≤1 drink/day for women or ≤2 drinks/day for men
	:*[[Physical activity]]: [[Aerobic]] ( 90–150 min/week), dynamic resistance (90–150 min/week), [[Isometric exercise\|Isometric]] resistance (4 × 2 min handgrip, 1 min rest between exercises, 3 sessions per week)		:*[[Physical activity]]: [[Aerobic]] ( 90–150 min/week), dynamic resistance (90–150 min/week), [[Isometric exercise\|Isometric]] resistance (4 × 2 min handgrip, 1 min rest between exercises, 3 sessions per week)
	:*~~Reduced [[alcohol]] intake~~: ~~Men ≤2 drinks daily, Women ≤1 drink daily~~		:*Stress reduction: Transcendental meditation (2 × 20 min/day) or device-guided slow breathing (<10 breaths/min for 15 min/day) may be reasonable adjuncts to lifestyle modification

	*Once diagnosed and treated, patients with hypertension are followed-up every month for evaluation of medication adherence and response to treatment.		*Once diagnosed and treated, patients with hypertension are followed-up every month for evaluation of medication adherence and response to treatment.

			=== Treatment Goal ===
			For all adults with confirmed hypertension, the recommended target is <130/80 mm Hg. For high-risk patients (10-year CVD risk ≥7.5% by PREVENT), achieving SBP <120 mm Hg is encouraged to reduce major adverse events.

	==References==		==References==

wikidoc - Changes related to "Gastric bypass surgery" [en]

Hypertension