Primary prevention

The lifetime risk for development of hypertension is high. Efforts should be made to minimise risk factors. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline recommends lifestyle modifications for patients with elevated blood pressure (BP), which is defined as 120 to 129/<80 mmHg.[3] Recommended lifestyle modifications include dietary changes, smoking cessation, increased physical activity, and reduced alcohol intake.[53][54]

Population-based approaches to prevent hypertension have been proposed: the American Public Health Association (APHA) has advocated for reduced sodium in the food supply, particularly in processed foods.[55] Although sodium reduction has a modest effect on BP lowering, the population effect on the huge number of at-risk people would potentially have significant consequences for cardiovascular morbidity and mortality.[56]​​ Use of salt substitutes has demonstrated BP-mediated protective effects for major cardiovascular events and mortality.[57][58]

The US Preventive Services Task Force (USPSTF) recommends that adults at increased risk of cardiovascular disease are offered behavioural counselling interventions to promote a healthy diet and physical activity; those not at high risk may also be considered for behavioural counselling interventions.[59][60]

Secondary prevention

Aggressive lifestyle modifications (dietary changes, smoking cessation, increased physical activity, reduced alcohol intake) should be initiated in patients with pre-hypertension (blood pressure [BP] 120-139/80-89 mmHg) to delay or prevent the onset of overt hypertension. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline defines elevated BP as 120 to 129/<80 mmHg and recommends lifestyle modification for these patients, which should be reassessed 3-6 months after initiation.[3] Other cardiovascular risk parameters should be aggressively managed. For example, statins should be used in accordance with guidelines in people with diabetes. Accordingly, patients with pre-hypertension or elevated BP should be evaluated for occult cardiovascular risk by screening for diabetes or dyslipidaemia with fasting blood sugar and lipid levels. Global cardiovascular risk should be assessed. American College of Cardiology: ASCVD risk estimator plus Opens in new window

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