Modification
Recommendation
Approximate systolic BP reduction, range
Weight reduction
Maintain normal body weight (BMI, 18.5–24.9 kg/m2)
5–20 mmHg per 10 kg weight loss
Adopt dietary approaches to stop hypertension
Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat
8–14 mmHg
Dietary sodium reduction
Reduce dietary sodium intake to no more than 100 meq/day (2.4 g sodium or 6 g sodium chloride)
2–8 mmHg
Physical activity
Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week)
4–9 mmHg
Moderation of alcohol consumption
Limit consumption to no more than two drinks (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than one drink per day in women and lighter-weight persons
2–4 mmHg
10.8.1.2 Pharmacologic Treatment
Initiate pharmacologic treatment if [1]*:
General population age ≥60 years if SBP ≥150 or DBP ≥90
Goal: SBP <150 and DBP <90
General population age <60 years or age ≥18 years with chronic kidney disease (CKD) or age ≥18 years with diabetes if SBP ≥140 or DBP ≥90
Goal: SBP <140 and DBP <90
Initial antihypertensive treatment should include [1]:
In general nonblack population:
A thiazide diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme (ACE) inhibitor, or angiotensin II receptor blockers (ARB) alone or in combination
In the general black population:
A thiazide diuretic or CCB alone or in combination
In patients with chronic kidney disease older than 18 years old:
ACE inhibitor or ARBs alone or in combination with other drug classes
In patients with heart failure:
Thiazide diuretics, ACE inhibitors, and CCBs are more effective, respectively.
JNC8 does not recommend α-blockers and β-blockers for the initial treatment of hypertension.
If the target BP is not reached within 1 month after starting treatment, either the dosage should be increased, or a second medication should be added (thiazide, CCB, ACE inhibitor, or ARB).
ACE inhibitors and ARBs should not be used together in the same patient.
*A recent NIH sponsored trial (SPRINT trial) suggests a lower SBP goal of <120 mmHg for patients ≥50 at high risk for cardiovascular events but without diabetes [11].
10.8.2 Antihypertensive Medications
Evidence-based dosing for antihypertensive drugs.*
10.8.3 ACE Inhibitors
Medication | Initial daily dose, mg | Target dose, mg | No. of doses per day |
|---|---|---|---|
Captopril | 50 | 150–200 | 2 |
Enalapril | 5 | 20 | 1–2 |
Lisinopril | 10 | 40 | 1 |
Pitfalls
Contraindicated in pregnancy, caution in women of child-bearing age.
May cause a chronic cough.
May cause life-threatening angioedema of head and neck.
Avoid in bilateral renal stenosis/renal impairment.
May cause high normal potassium or hyperkalemia.
May cause increase in serum creatinine.
Captopril may cause neutropenia with myeloid hypoplasia and agranulocytosis especially in patient with renal impairment.
10.8.4 Angiotensin Receptor Blockers
Medication | Initial daily dose, mg | Target dose, mg | No. of doses per day |
|---|---|---|---|
Eprosartan | 400 | 600–800 | 1–2 |
Candesartan | 4 | 12–32 | 1 |
Losartan | 50 | 100 | 1–2 |
Valsartan | 40–80 | 160–320 | 1 |
Irbesartan | 75 | 300 | 1 |
Pitfalls
Contraindicated in pregnancy, caution in women of child-bearing age
Avoid in bilateral renal stenosis
May cause angioedema
May cause high normal potassium or hyperkalemia
May cause increase in serum creatinine
10.8.5 β-Blockers
Medication | Initial daily dose, mg | Target dose, mg | No. of doses per day |
|---|---|---|---|
Atenolol | 25–50 | 100 | 1 |
Metoprolol
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