A Proposed Approach to Attaining Blood Pressure Goal
George Bakris, MD, FASN, FAHA
From the University of Chicago School of Medicine, Chicago, Illinois
Address correspondence to: George Bakris, MD, FASN, FAHA
University of Chicago Medical Center
5841 S. Maryland Avenue, MC 1027
Chicago, IL 60637
Telephone: 773-702-7936 Fax: 773-834-0486
Key Words: Antihypertensive agents, monotherapy, combination therapy
The goal of this article is to help clinicians achieve blood pres-
sure (BP) goals set forth by guidelines. These guidelines are
from both the United States and Europe, since clinicians in
these areas generally agree on specific BP goals for hyperten-
sion in the presence and absence of concomitant diseases,
such as diabetes and kidney disease.1–4
First, please note that all recommendations for treatment in
this article are based on a solid foundation of lifestyle modifi-
cations. Reducing sodium intake and increasing exercise play
an important role in treating patients with hypertension.
Regular exercise, weight loss, and restriction of sodium to
less than 3 g per 24 hours all help to decrease BP.
Pharmacological treatment should be initiated in patients
who still have elevated BP (ie, > 140/90 mm Hg) after lifestyle
modifications have been instituted and followed.
For patients with hypertension and no other comorbidities, treat-
ment should be directed at achieving a goal BP of < 140/90 mm
Hg. In patients with diabetes or chronic kidney disease, the goal
is < 130/80 mm Hg.
Monotherapy Versus Combination Therapy
A minority of people will require monotherapy to achieve BP goals.
Based on estimates from clinical trials, about 25% of all people with
hypertension can achieve their BP goals with monotherapy.5 If
monotherapy is indicated, most guidelines suggest that any class of
drugs except perhaps beta blockers be used as first-line therapy.
Beta blockers are appropriate if a specific coexisting disease
requires them. Most clinical outcome trials