Treatment and control of high blood pressure in adults

Hypertension and prehypertension are major public health challenges. Prevention and control of prehypertension through lifestyle changes and the treatment of hypertension to goal blood pressure (BP) are important objectives. In most patients, 2 or more medications with complementary mechanisms of action should be used in combination. Referral for evaluation of resistant hypertension should be made when goal BP is not attained while patients are adherent on 3 or more appropriately dosed antihypertensive medications, including a diuretic. There are compelling indications for the use of specific drugs in patients with underlying ischemic heart disease, chronic heart failure, diabetes, chronic kidney disease, stroke, peripheral arterial disease, left ventricular hypertrophy, obesity, and metabolic syndrome. Adverse drug effects should be identified early and managed promptly to address patient safety and adherence. Other factors that affect adherence include the patient's health literacy level and ability to self-manage. The social, environmental, cultural, and financial sources of support in care must be addressed to achieve the full benefits of treatment and control of hypertension and prehypertension.