Part 6

-Anti-hypertensive drugs

-Drugs affecting blood

-Hypocholesterolemic drugs

-Anemia

Classification and Management of Blood Pressure for Adults

Initial Drug Therapy

BP
Classification

SBP,* mm Hg

DBP,* mm Hg

Lifestyle modifications

Without Compelling Indications

With Compelling Indications

Normal

<120

And <80

Encourage

Prehypertension

120-139

Or
80-89

Yes

No antihypertensive drug indicated

Drug(s) for compelling indications†

Stage 1 Hypertension

140-159

Or
90-99

Yes

Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination

Drug(s) for the compelling indications.‡ Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed

Stage 2 Hypertension

> 160

Or >100

Yes

Two-drug combination for most† (usually thiazide-type diuretic and ACEI or ARB or BB or CCB)

DBP=diastolic blood pressure, SBP=systolic blood pressure.
Drug abbreviations: ACEI=angiotensin converting enzyme inhibitor; ARB=angiotensin receptor blocker; BB=beta-blocker; CCB=calcium channel blocker
* Treatment determined by highest blood pressure category
† Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension.
‡ Treat patients with chronic kidney disease or diabetes to blood pressure goal of <130/80 mmHg.
Adapted from JNC VII

Table 1:

Classification of Blood Pressure (JNC VII)

Systolic BP, mm Hg

Diastolic BP, mm Hg

Normal

<120

and <80

Prehypertension

120-139

or 80-89

Stage 1 hypertension

140-159

or 90-99

Stage 2 hypertension

>160

or >100

Table 2:

Lifestyle Modifications to Manage Hypertension *†

Modification

Recommendation

Approximate SBP
Reduction Range

Weight
reduction

Maintain normal body weight (body mass index 18.4-24.9 kg/m2).

5-20 mm Hg/
10 kg weight loss

Adopt DASH eating plan

Consume a diet rich in fruits, vegetables, and low fat dairy products with a reduced content of saturated and total fat.

8-14 mm Hg

Dietary sodium reduction

Reduce dietary sodium intake to no more than 100 mmol per day (2.4 g sodium or 6 g sodium chloride)

2-8 mm Hg

Physical
activity

Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes/day, most days of the week)

4-9 mm Hg

Moderation of alcohol consumption

Limit consumption to no more than 2 drinks (1 oz or 30 mL ethanol; eg, 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and no more than 1 drink per day in women and in lighter weight persons.

2-4 mm Hg

DASH = Dietary Approaches to Stop Hypertension
* For overall cardiovascular risk reduction, stop smoking
† The effects of implementing these modifications are dose- and time-dependent, and could be greater for some individuals
Adapted from JNC VII

Table 3:

Classification and Management of Blood Pressure for Adults

Initial Drug Therapy

BP
Classification

SBP,* mm Hg

DBP,* mm Hg

Lifestyle modifications

Without Compelling Indications

With Compelling Indications

Normal

<120

And <80

Encourage

Prehypertension

120-139

Or
80-89

Yes

No antihypertensive drug indicated

Drug(s) for compelling indications†

Stage 1 HypertensionCOLOR

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