Hypertension: Practice changers resulting from the new guidelines

Follow-up and nonpharmacologic care
“If patients have low atherosclerotic risk and an SBP that is 120 to 129 mm Hg, you can repeat the BP measurement after up to 6 months of lifestyle changes,” said Davis. “These guidelines don’t add anything magical about lifestyle changes,” Davis explained. “It’s stuff we’ve known” and been doing for a long time, such as the DASH diet and weight loss, which “are as good as low-dose medication at reducing BP in many cases.”

She cautioned, however, that with patients who are Stage 1 and Stage 2, “Don’t wait too long to bring them back; bring them back within a month.” She said that most patients with Stage 1 hypertension are managed with a combination of lifestyle changes and a medication, while those with Stage 2 hypertension are often started on 2 medications at once, along with lifestyle changes.

Lastly, Davis explained that older adults are defined as those ≥65 years of age, and that this population can range widely from those who are ambulatory and well to those who have many comorbid conditions. As a result, practitioners really need to talk to these patients and perhaps their families to determine through shared decision-making what treatment is necessary.