Hypertension management
During a blood pressure visit, your doctor confirms high readings by averaging measurements over several visits or using
home/ambulatory monitors. They ask about your personal and family history of high blood pressure, heart disease,
diabetes and cholesterol, and review your current medicines and lifestyle habits, including salt intake, diet, exercise,
sleep, alcohol, tobacco and stimulant use. A physical examination looks for signs of heart, lung, kidney, nerve or eye
problems. Your doctor screens for secondary causes such as sleep apnea, thyroid or adrenal disorders, kidney disease or
certain medications, especially if you are young or have very high blood pressurehttps://www.aafp.org/pubs/afp/issues/2023/1000/hypertension-adults.html#:~:text=Evaluation. Risk
calculators like the ASCVD estimator help determine your cardiovascular risk.
First‑line medicines to lower blood pressure include thiazide diuretics, ACE inhibitors, angiotensin‑receptor blockers
(ARBs) and calcium channel blockers. Diuretics help your kidneys move extra salt and water out of your body so your
blood vessels relaxhttps://my.clevelandclinic.org/health/treatments/21811-antihypertensives#:~:text=%23%20Diuretics%20%28including%20potassium,type%20diuretics. ACE inhibitors stop your body from making angiotensin II, a chemical
that tightens arteries; side effects can include a dry cough and high potassiumhttps://my.clevelandclinic.org/health/treatments/21811-antihypertensives#:~:text=%23%20Angiotensin. ARBs block
the effects of angiotensin II and may cause dizziness or high potassiumhttps://my.clevelandclinic.org/health/treatments/21811-antihypertensives#:~:text=,ARBs. Calcium channel
blockers prevent calcium from entering the muscle cells of your heart and blood vessels, letting them relax but
sometimes causing headaches or ankle swellinghttps://my.clevelandclinic.org/health/treatments/21811-antihypertensives#:~:text=,dihydropyridines%20and%20nondihydropyridines. Additional classes such as beta‑blockers,
alpha‑agonists, aldosterone antagonists and vasodilators may be added when needed, especially for heart disease or
kidney problems. Many people need two or more medicines to reach their blood pressure goal, and your doctor will adjust
treatment based on side effects and other conditions.
Initial testing usually includes a 12‑lead electrocardiogram to assess your heart rhythm; blood glucose and hemoglobin
A1C to screen for diabetes; a complete blood count (hematocrit) to look for anemia; a fasting lipid panel to check LDL,
HDL and triglycerides; serum calcium, sodium and potassium levels; and serum creatinine with estimated glomerular
filtration rate to evaluate kidney function. A urine test for protein (albumin‑to‑creatinine ratio) or routine
urinalysis detects early kidney damagehttps://www.aafp.org/pubs/afp/issues/2023/1000/hypertension-adults.html#:~:text=12,to%20creatinine%20ratio%20or%20urinalysis. Depending on your situation, your doctor may order
thyroid, cortisol or hormone tests to look for secondary causes of hypertension. These labs are also used to monitor
medication side effects.
Most people with high blood pressure do not need imaging. If your doctor suspects heart damage or another cause of
hypertension, they may order an echocardiogram to examine your heart muscle and valves, a renal ultrasound or CT scan to
look for kidney disease or narrowing of the kidney arteries, or a chest X‑ray to assess heart size. Imaging is reserved
for resistant or complicated cases and is not part of routine screening.
Seek immediate care if you develop a severe headache, chest pain, shortness of breath, weakness or vision changes, or if
your blood pressure is higher than 180/120 mm Hg—these may indicate a hypertensive emergency. Persistent dizziness,
fainting, swelling, or a persistent cough on ACE inhibitors should be discussed with your doctor. Symptoms suggesting
secondary causes, such as snoring and gasping (sleep apnea), muscle weakness, unexpected weight gain or loss, sweating,
or tremors, also warrant evaluation.
After starting or changing medicines, doctors usually check your blood pressure and labs within about one month. Once
your pressure is near your target and stable, follow‑up visits are typically scheduled every
3–6 monthshttps://www.ncbi.nlm.nih.gov/books/NBK573627/#:~:text=HTN%20to%20be%20a%20reasonable,should%20be%20viewed%20as%20suggestions. More frequent visits may be needed if your blood pressure is very high, you have
other medical problems, or medicines cause side effects. Home blood pressure monitoring helps track control between
visits, and yearly lab work screens for complications.
Lifestyle changes are the foundation of blood pressure control. A DASH‑style diet rich in fruits, vegetables, whole
grains, beans, low‑fat dairy and lean proteins, and low in saturated fat, sugar and red meat, helps lower blood
pressure. Limiting sodium to 1,500 mg per day or cutting salt intake by at least 1,000 mg lowers blood pressure
independentlyhttps://www.aafp.org/pubs/afp/issues/2023/1000/hypertension-adults.html#:~:text=Physicians%20should%20counsel%20all%20patients,20%7D%20The%20benefit%20of%20sodium. Regular physical activity—at least 150 minutes per week of moderate‑intensity
exercise like brisk walking or 75 minutes of vigorous exercise—reduces systolic and diastolic
pressureshttps://www.aafp.org/pubs/afp/issues/2023/1000/hypertension-adults.html#:~:text=Regular%20aerobic%20exercise%20lowers%20systolic,18%7D%20Weight%20loss%20reduces%20blood. Losing even 4 kg (about 9 lb) lowers blood pressurehttps://www.aafp.org/pubs/afp/issues/2023/1000/hypertension-adults.html#:~:text=combination%20of%20both%20for%20cardiovascular,the%20effects%20on%20mortality%20are.
Moderating alcohol (no more than one drink per day), avoiding tobacco, limiting caffeine, managing stress, and getting
adequate sleep all contribute to lower blood pressure. Home blood pressure monitoring and medication adherence are key
to long‑term control.
Your primary care provider coordinates blood pressure care. They may involve a cardiologist or nephrologist if your
hypertension is hard to control or you have heart or kidney complications. An endocrinologist helps evaluate hormonal
causes. A sleep specialist can test for sleep apnea. A dietitian can provide nutrition counseling for the DASH diet and
weight loss. Pharmacists and nurses may assist with blood pressure monitoring and medication adjustments. Community
health workers or telemedicine programs can support adherence and lifestyle changes.