Management of hypertension

[9] A 2012 Cochrane review found that medications for mild hypertension did not reduce the risk of death, stroke, or cardiovascular disease, but did cause side effects in 1 of every 12 people.

[8][10] A second review that looked at higher-risk people (mostly diabetics whose blood pressure was difficult to control) found the medication prevented stroke for 1 in 223 and death for 1 in 110 who took it.

[10] If there are benefits to treating people with mild hypertension, they appear to occur primarily among those at highest risk, though all groups experience side effects at a similar rate (1 in 12).

[21] Meta-analyses conducted by the Cochrane Hypertension group have found no evidence of an appreciable blood pressure reduction from any combination of calcium, magnesium, or potassium supplements; this information stands contrary to prior systematic reviews suggesting that a dietary intake adjustment for each of these may benefit adults with high blood pressure.

[11][28] Compared to placebo, beta-blockers have a greater benefit in stroke reduction, but no difference on coronary heart disease or all-cause mortality.

[35] Combinations of an ACE-inhibitor or angiotensin II–receptor antagonist, a diuretic, and an NSAID (including selective COX-2 inhibitors and non-prescribed medications such as ibuprofen) should be avoided whenever possible due to a high documented risk of acute kidney failure.

[39] A study published in December 2018 by Clinical Cardiology showed that a home-based program involving a Bluetooth-enabled blood pressure monitoring device reduced hypertension in seven weeks.

[40] Treating moderate to severe hypertension decreases death rates and cardiovascular morbidity and mortality in people aged 60 and older.

[41] The recommended blood pressure goal is advised as <150/90 mmHg, with thiazide diuretic, CCB, ACEI, or ARB being the first-line medication in the United States.

[42] In the revised UK guidelines, calcium-channel blockers are advocated as first line, with targets of clinic readings <150/90, or <145/85 on ambulatory or home blood pressure monitoring.

[48] This low adherence to blood pressure treatment is the result of many patients’ generally poor health literacy, costly antihypertensive medications, and inability to accurately follow complex regimens.

[49] Some common secondary causes of resistant hypertension include obstructive sleep apnea, pheochromocytoma, renal artery stenosis, coarctation of the aorta, and primary aldosteronism.

[51] A 2014 consensus statement from the Joint UK Societies recommended that radiofrequency ablation not be used to treat resistant hypertension,[53] but supported continuing clinical trials.

Patient selection, with attention to measurement of pre- and post-procedure sympathetic nerve activity and norepinephrine levels, may help differentiate responders from non-responders to this procedure.

[58][59][60] The lower target was associated with a 0.5% annual absolute decrease in cardiovascular episodes and all-cause mortality (relative risk 0.75), but also an increased rate of serious adverse events.