Primary prevention

The lifetime risk for development of hypertension is high. Efforts should be made to minimise risk factors. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline recommends lifestyle modifications for patients with elevated blood pressure (BP), which is defined as 120 to 129/<80 mmHg, and for people with white coat hypertension.[2] Recommended lifestyle modifications include dietary changes, smoking cessation, increased physical activity, and reduced alcohol intake.[56][57]

Population-based approaches to prevent hypertension have been proposed: the American Public Health Association (APHA) has advocated for reduced sodium in the food supply, particularly in processed foods.[58] Although sodium reduction has a modest effect on BP lowering, the population effect on the huge number of at-risk people would potentially have significant consequences for cardiovascular morbidity and mortality.[59]​​ Use of salt substitutes has demonstrated BP-mediated protective effects for major cardiovascular events and mortality.[60][61]

The US Preventive Services Task Force (USPSTF) recommends that adults at increased risk of cardiovascular disease are offered behavioural counselling interventions to promote a healthy diet and physical activity; those not at high risk may also be considered for behavioural counselling interventions.[62][63]

Secondary prevention

Aggressive lifestyle modifications (dietary changes, smoking cessation, increased physical activity, reduced alcohol intake) should be initiated in patients with pre-hypertension (blood pressure [BP] 120-139/80-89 mmHg) to delay or prevent the onset of overt hypertension. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline defines elevated BP as 120 to 129/<80 mmHg and recommends lifestyle modification for these patients, which should be reassessed 3-6 months after initiation.[2] Other cardiovascular risk parameters should be aggressively managed. For example, statins should be used in accordance with guidelines in people with diabetes. Accordingly, patients with pre-hypertension or elevated BP should be evaluated for occult cardiovascular risk by screening for diabetes or dyslipidaemia with fasting blood sugar and lipid levels. Global cardiovascular risk should be assessed. [ ASCVD Risk Estimator Plus Opens in new window ] ​​

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