HTN: Management

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962701/

Nonpharmacologic approach:

• Lifestyle changes

  • Diet

    1. DASH diet: Dietary Approaches to Stop Hypertension

       1. High in fruits, vegetables, low-fat milk products, whole grains, fish, poultry, nuts, and lean red meats

       2. Limited sugar and sweets

  • Exercise

    1. Moderate intensity, at least 3 days per week

Pharmacologic management:

• First-line agents:

  • Angiotensin-converting enzyme (ACE) inhibitors

  • Angiotensin II receptor blockers (ARBs)

  • Calcium channel blockers, long-acting

  • Thiazide diuretics

• Second-line agents:

  • Beta blockers

    1. Asthma is a relative contraindication

    2. Can limit maximum heart rate: avoid in patients with exercise intolerance or competitive athletes

  • Clonidine - centrally acting α-agonist

    1. Usually as transdermal patch

  • Direct-acting vasodilators (smooth muscle relaxants)

    1. Hydralazine

• Target BP:

  • In patients with CKD: <90%ile

  • Patients without CKD: <95%ile + 12 mmHg