Primary prevention

The lifetime risk for development of hypertension is high. Efforts should be made to minimize risk factors, especially in patients with pre-hypertension (defined as 120 to 139/80 to 89 mmHg); these patients should be proactively counseled to effect lifestyle modifications so as to reduce their risk of developing hypertension. The 2017 American College of Cardiology/American Heart Association guideline introduced a new category, elevated blood pressure, which is defined as 120 to 129/<80 mmHg and recommends lifestyle modification for these patients.[5] Recommended lifestyle modifications include dietary changes, smoking cessation, increased physical activity, and reduced alcohol intake.

Population-based approaches to prevent hypertension have been proposed: the American Public Health Association has advocated for reduced sodium in the food supply, particularly in processed foods.[43] Although sodium reduction has a modest effect on blood pressure lowering, the population effect on the huge number of at-risk people would potentially have significant consequences for cardiovascular morbidity and mortality.[44]

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 120-139/80-89 mmHg) to delay or prevent the onset of overt hypertension. The 2017 American College of Cardiology/American Heart Association guideline defines elevated blood pressure as 120 to 129/<80 mmHg and recommends lifestyle modification for these patients, which should be reassessed 3 to 6 months after initiation.[5] 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 blood pressure should be evaluated for occult cardiovascular risk by screening for diabetes or dyslipidemia with fasting blood sugar and lipid levels. Global cardiovascular risk should be assessed. American College of Cardiology: ASCVD risk estimator plus external link opens in a new window

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