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  • Image not available. The risk of cardiovascular (CV) morbidity and mortality is directly correlated with blood pressure (BP).
  • Image not available. Evidence from clinical trials have shown that antihypertensive drug therapy substantially reduces the risks of CV events and death in patients with high BP.
  • Image not available. Essential hypertension is usually an asymptomatic disease. A diagnosis cannot be made based on one elevated BP measurement. An elevated value from the average of two or more measurements, present during two or more clinical encounters, is needed to diagnose hypertension.
  • Image not available. The overall goal of treating hypertension is to reduce hypertension-associated morbidity and mortality from CV events. These are considered hypertension-associated complications. The selection of specific drug therapy should be based on evidence that demonstrates CV risk reduction.
  • Image not available. A goal BP of <140/90 mm Hg is appropriate for general prevention of CV events and CV risk reduction in most patients. For some patients (e.g., diabetes and/or significant chronic kidney disease) lower goal BP values may be appropriate on a patient-specific basis.
  • Image not available. Magnitude of BP elevation should be used to guide determination of the number of agents to start when implementing drug therapy. Most patients with stage 1 hypertension should be started on one drug, with the option of starting two for some patients. However, most patients presenting with stage 2 hypertension should be started on two drugs.
  • Image not available. Lifestyle modifications should be prescribed in all patients, especially those with prehypertension and hypertension. However, they should never be used as a replacement for antihypertensive drug therapy for patients with hypertension, especially in those with additional CV risk factors.
  • Image not available. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide diuretics are all first-line agents for most patients with hypertension for general prevention of CV events and CV risk reduction. These first-line options are for patients with hypertension who do not have any compelling indications for a specific antihypertensive drug class.
  • Image not available. For general prevention of CV events and CV risk reduction in most patients with hypertension, β-blockers do not reduce CV events to the extent that has been proven with thiazide-type diuretics, ACE inhibitors, ARBs, CCBs, or thiazide diuretics.
  • Image not available. Compelling indications are comorbid conditions where specific antihypertensive drug classes have been shown in clinical trials to provide unique long-term benefits (reducing the risk of CV events).
  • Image not available. Patients with diabetes are at high risk for CV events. All patients with diabetes and hypertension should ideally be managed with either an ACE inhibitor or an ARB. These are typically in combination with one or more other antihypertensive agents because multiple agents frequently are needed to control BP.
  • Image not available. Older patients are often at risk for orthostatic hypotension when antihypertensive drug therapy is started. Although overall antihypertensive drug therapy should be the same as in younger patients, low initial doses should be used and dosage titrations should be gradual to minimize risk of orthostatic hypotension.
  • Image not available. Alternative antihypertensive agents have not been proven to reduce the risk of CV events to the same extent compared with first-line antihypertensive agents. They should be used primarily in combination with first-line agents to provide additional BP lowering.
  • Image not available. Initial therapy with the combination of two antihypertensive agents should be used in most patients presenting with stage 2 hypertension. This is also an option for ...

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