Management of Essential Hypertension: A Comprehensive Review of Current Guidelines and Evidence-Based Practices

Essential hypertension is a common cardiovascular issue that significantly impacts global health. According to recent American clinical guidelines, approximately 50% of adults in the developed country have hypertension, yet only about half of these individuals receive treatment, and just a quarter have their condition adequately controlled. Effective management of high blood pressure is vital to reduce morbidity and mortality and enhance patient outcomes.

This review estimated both non-pharmacological approaches and pharmacological interventions and aimed to provide a thorough and current overview of cardiology guidelines and evidence-based research concerning essential hypertension, with an emphasis on personalised treatment plans for patients’ specific risk profiles and comorbidities.

This review serves as a contemporary reference for clinicians, enhancing their understanding of treatment goals and strategies by summarizing the latest developments in hypertension management.

The management of essential hypertension involves both non-pharmacological and pharmacological strategies:

Non-Pharmacological Management:

• Lifestyle Modifications: Key strategies include weight loss, adherence to healthy diets (DASH and Mediterranean), reduced sodium and increased potassium intake, regular physical activity, moderation of alcohol consumption, and smoking cessation.
• Weight Loss: A 6-8% reduction in body weight can significantly lower blood pressure (BP).
• Physical Activity: Regular moderate to high-intensity aerobic exercise and resistance training are effective in lowering BP.
• Diet: Emphasizes fruits, vegetables, and low intake of red/processed meats while recommending sodium reduction.
• Alcohol and Smoking: Limiting alcohol and cessation of smoking are crucial for cardiovascular health.

Pharmacological Management:

• Diuretics: Thiazide and thiazide-like diuretics are effective and well-tolerated.
• RAAS Inhibitors: ACE inhibitors and ARBs are effective, with ARBs preferred for better tolerability.
• Calcium Channel Blockers (CCBs): Long-acting dihydropyridines are effective for BP control.
• Beta-Blockers: Generally reserved for specific conditions rather than first-line treatment.

Novel Therapies:

Emerging treatments include Zilebesiran and neprilysin inhibitors, along with interventional therapies like renal denervation for resistant hypertension.

To summarize, by applying evidence-based recommendations, healthcare providers can improve patient care, reduce complications, and enhance overall outcomes for individuals with essential hypertension. 

Source: Moiz A, Zolotarova T, Eisenberg MJ. Outpatient management of essential hypertension: a review based on the latest clinical guidelines. Ann Med. 2024 Dec;56(1):2338242. doi: 10.1080/07853890.2024.2338242. Epub 2024 Apr 11. PMID: 38604225; PMCID: PMC11011233.