Clinical strategies for optimal hypertension management

In the United States, approximately 25% of the adult population older than 40 years has hypertension. Americans have a 90% chance of developing hypertension during their lifetime, with the disease prevalence increasing sharply with the population's advancing age. Regardless of the stage at which hypertension is discovered, lifestyle modifications offer first-line treatment for most patients because they can effectively reduce cardiovascular risk and lower blood pressure, and may reduce the number and dosage of antihypertensive medications required by patients on drug therapy. Clinical implementation of the recommendations of the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, along with public health approaches such as reducing calories, saturated fat, and salt and increasing physical activity, promote a downward shift in the population distribution of blood pressure trends and provide an important opportunity to interrupt and prevent the continuing costly cycle of managing hypertension and its complications. This article additionally reviews the principles of hypertension care in special patient populations. In particular, hypertension in patients with diabetes mellitus deserves special attention because of the associated increased risk for macrovascular and microvascular complications leading to the increased incidence of coronary events, blindness, and other devastating clinical outcomes.