Hypertension

•RCT evidence— Decades of outcomes trials

Why aggressive treatment pays

SPRINT and STEP showed lowering systolic BP to <120 (intensively measured) reduces cardiovascular events and all-cause mortality in high-risk older adults. Even modest 5 mmHg systolic reductions produce roughly 10% relative reductions in major events.

Lifestyle foundation

• DASH or Mediterranean-style diet (-5 to -10 mmHg).
• Weight loss (~1 mmHg per kg lost in obese).
• Sodium reduction (-2 to -8 mmHg if salt-sensitive).
• Aerobic exercise (-4 mmHg) + resistance training.
• Alcohol moderation.
• Stress management.

Drug classes

Class	Examples	Notes
ACE inhibitors	lisinopril, ramipril, perindopril	First-line; cough side-effect
ARBs	losartan, telmisartan, valsartan	First-line; no cough
Calcium-channel blockers	amlodipine, nifedipine	Effective; ankle oedema
Thiazide-like	chlorthalidone, indapamide	More potent than HCTZ
Mineralocorticoid antagonists	spironolactone, eplerenone	For resistant HTN
Beta-blockers	bisoprolol, metoprolol	Less first-line unless concurrent CAD/HF

Single-pill combination therapy improves adherence and is now preferred initial strategy in moderate-severe hypertension.

Resistant hypertension

BP not controlled on three drugs including a diuretic at maximum tolerated doses. Workup: secondary causes (primary aldosteronism, renovascular, OSA), adherence assessment, ambulatory monitoring, optimise diuretic. Add spironolactone.

Related entries

Blood pressure, SPRINT, DASH diet, Sleep apnea.