Long Range Goals

The long range goals of therapy are to prevent the morbidity and mortality associated with hypertension. This should be achieved with a program that is simple, low cost and has the least side effects. The patient's blood pressure should be maintained at less than 140/90 mmHg, with concurrent control of other modifiable risk factors. In patients with diabetes or chronic renal disease, the blood pressure should be maintained at less than 130/80 mmHg.

Patient education is critical. They should be informed of the risks of target organ damage, including disability and death. It should be stressed that treatment is usually lifelong and reduces their risks. They and their families should participate in their own health care, for example, learning to take their own blood pressure.

Weight reduction reduces blood pressure in the vast majority of hypertensive patients who are above their ideal weight. It also enhances the blood pressure lowering effects of antihypertensive drugs. Weight loss also reduces cardiovascular risk factors, especially when coupled with dietary fat restriction. In overweight patients with prehypertension or stage 1 hypertension, weight loss alone may control the blood pressure.

Patients can achieve reasonable salt restriction of less than 6 grams per day if they avoid salty foods and add no salt. Salt restriction also enhances drug efficacy and reduces the need for potassium supplementation in patients treated with diuretics.

A regular program of aerobic exercise may be beneficial for the prevention and treatment of hypertension. It also enhances weight loss and reduces cardiovascular risk. Excessive alcohol can cause hypertension and should be limited in men to one ounce of ethanol, or 2 drinks per day, and in women to half an ounce or one drink per day. Smoking is a major risk factor for cardiovascular disease and should be totally avoided.