This document provides guidelines for lowering high blood pressure in adults. It outlines that hypertension is very common, affecting 1 in 3 adults in the U.S. It can damage organs like the brain, heart, kidneys, and arteries. The guidelines recommend treating hypertension to a goal of below 140/90 mmHg or 130/80 mmHg for those with diabetes or kidney disease to reduce health risks. Lifestyle changes like losing weight, eating healthy, reducing sodium, and increasing exercise can naturally lower blood pressure. Medications may also be needed to control hypertension. Patients should be regularly monitored until their blood pressure is controlled.

1. Clinical Guidelines—
Lowering High Blood
Pressure in Adults

2. Hypertension
Scope
High Blood Pressure
(hypertension)
•is the most common
primary diagnosis in the
U.S.,
•affects approximately 1
in 3 adults in the U.S.,
and
•affects more than 65% of
people over 65 years old.
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3. Hypertension
Effects
Hypertension can damage the
Brain Heart
It’s the most It’s a major risk factor
important risk factor for heart attack and the
for stroke. #1 risk for congestive
heart failure.
Kidneys Arteries
It can cause the It’s associated with
kidneys to fail, stiffer arteries,
resulting in dialysis causing the heart and
or a kidney kidneys to work
transplant. harder.
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4. Hypertension
Adults at Risk
Percentage of adults with hypertension by age
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5. Hypertension
Adults at Risk
Percentage of adults with hypertension by ethnicity
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6. Hypertension
Adults at Risk
Percentage of
adults with
hypertension
by state
(Source: CDC Behavioral
Risk Factor Surveillance
System)
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7. Blood Pressure
Know the Numbers
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8. Blood Pressure
Cardiovascular Disease (CVD)
According to the 7th Report from the Joint National Committee
on Prevention, Detection, Evaluation, and Treatment of
High Blood Pressure (JNC7)
•BP relationship to risk of CVD is “continuous, consistent,
and independent of other risk factors.”
•For people 40-70 years old, each increment of 20/10 mmHg
doubles the risk of CVD across the entire BP range,
starting from 115/75 mmHg.
•Hypertension can be prevented if prehypertension is
discovered.
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9. Blood Pressure
Benefits of Lowering
Heart Stroke Myocardial
Failure Incidence Infarction
(Source: JNC7)
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10. Hypertension
Evaluation
1. Assess lifestyle and identify major CVD risk factors or
concomitant disorders that affect prognosis and
guide treatment.
2. Identify causes of hypertension.
3. Assess the presence or absence of target organ
damage and CVD.
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11. Hypertension Evaluation
1. Assess Lifestyle & CVD Risk Factors
Assess Lifestyle Identify CVD Risk Factors
•Weight •Hypertension
•Eating routine •Obesity
•Sodium intake •Dyslipidemia
•Physical activity •Diabetes mellitus
•Alcohol consumption •Microalbuminuria or estimated
•Smoking habits glomerular filtration rate <60 ml/min
•Age
•Family history of premature CVD*
*CVD is considered premature when it occurs in men <55 years and women age <65 years.
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12. Hypertension Evaluation
2. Identify Causes of Hypertension
Identify Causes of Hypertension
•Sleep apnea
•Drug-related causes
•Chronic kidney disease (CKD)
•Primary aldosteronism
•Renovascular disease
•Chronic steroid therapy and Cushing’s syndrome
•Pheochromocytoma
•Coarctation of the aorta
•Thyroid or parathyroid disease
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13. Hypertension Evaluation
3. Assess Presence of Target Organ Damage
Brain Kidneys
• Stroke or transient • CKD
ischemic attack
Arteries
Heart • Peripheral arterial
• Left ventricular hypertrophy disease
• Angina or prior myocardial
infarction Eyes
• Prior coronary
• Retinopathy
revascularization
• Heart failure
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14. Treatment
Goal of Therapy
• Reduce CVD and renal morbidity and mortality.
• Treat to BP <140/90 mmHg or BP <130/80 mmHg in
patients with diabetes or CKD.
• Achieve the systolic BP (SBP) goal, which is especially
important in persons ≥50 years old.
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15. Treatment
Lifestyle Modification
Modify Lifestyle to Reduce SBP approximately
•Reduce weight 5-20 mmHg/10kg weight loss
•Adopt healthy eating plan 8-14 mmHg
•Reduce dietary sodium intake 2-8 mmHg
•Increase physical activity 4-9 mmHg
•Moderate alcohol intake 2-4 mmHg
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16. Treatment
Pharmacological
•Lowering BP with several classes of drugs will reduce the
•Most hypertension patients will need two or more
(*See algorithm for Treatment of Hypertension in the JNC7 report)
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17. Treatment
Other Considerations
• CVD risk factors should be treated and
tobacco avoided.
• Low-dose aspirin therapy should be
considered but only when BP is
controlled (risk of hemorrhagic strokes
increases in patients with uncontrolled
hypertension).
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18. Care Management
Follow-Up
Patients should be checked:
•monthly for follow-up and
medication adjustment until BP goal
is reached
•more frequently for Stage 2
Hypertension or complicating
comorbid conditions
•1-2 times/year to check serum
potassium and creatinine
•every 3-6 months after BP is stable
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19. Care Management
Follow-Up
Additional factors that can affect how often patients should
follow-up with their physicians:
Comorbidities Other special considerations
• Ischemic heart disease • Minorities
• Heart failure • Obesity
• Diabetic hypertension • Left ventricular hypertrophy
• CKD • Peripheral arterial disease
• Cerebrovascular disease • Hypertension in older persons
• Postural hypotension
Need for additional • Dementia
lab tests • Gender and age
• Urgencies and emergencies
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20. The Patient’s Choice
The patient must be
motivated to follow his/her
care management plan and
to establish and maintain a
healthy lifestyle.
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21. The Patient’s Choice
Barriers to motivation
The patient might
•not understand the •not afford the medication
condition or treatment •not have transportation to
•deny the illness appointments
•dislike taking medication
•feel uninvolved in his/her
healthcare plan
•feel uncomfortable talking
to the healthcare team
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22. Patient Tools and Resources
For Motivation and Self-Management
Lifestyle Management
http://www.nhlbi.nih.gov/hbp/prevent/h_eating/h_eating.htm
Medications – Types & Tips
http://www.nhlbi.nih.gov/hbp/treat/treat.htm
Understanding Blood Pressure Readings
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/U
nderstanding-Blood-Pressure-Readings_UCM_301764_Article.jsp
HBP Risk Calculator
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/WhyBloodPressureMatters/
Assess-Your-High-Blood-Pressure-Related-Risks_UCM_301829_Article.jsp
HBP Tracker
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/HighBloodPressureToolsR
esources/Blood-Pressure-Trackers_UCM_303465_Article.jsp
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23. Contact
Sandy Pogones
spogones@primaris.org
314-374-6451
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24. Resources
• The 7th Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure (JNC7)
• Million Hearts Blood Pressure Toolkit
• National Heart Lung and Blood Institute (NHLBI)
• NHLBI: Culturally Appropriate Education Materials
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