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Hypertension: Who should be treated?

Johannes FE Mann, MD
Karl F Hilgers, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc


Treatment of hypertension generally begins with nonpharmacologic therapy, including moderate dietary sodium restriction, weight reduction in the obese, avoidance of excess alcohol intake, and regular aerobic exercise (table 1) [1,2]. Institution of these modalities involves little or no risk and they all may be beneficial from a general health viewpoint even in normotensive subjects. (See "Diet in the treatment and prevention of hypertension".)

Drug therapy, in comparison, may be expensive and is often associated with side effects, some of which (hypokalemia and hyperlipidemia) may actually increase coronary risk. (See "Causes of hypokalemia in adults", section on 'Diuretics' and "Antihypertensive drugs and lipids".)

Thus, there should be clear evidence of likely benefit before antihypertensive drugs are begun. Such evidence is available for most degrees of hypertension [1,3,4].

The evidence that treating different degrees of hypertension is beneficial will be reviewed here, with recommendations for who should be treated. An overview of the treatment of hypertension, the choice of antihypertensive drug as initial therapy, and goal blood pressure are discussed separately. (See "Overview of hypertension in adults", section on 'Treatment' and "Choice of drug therapy in primary (essential) hypertension" and "What is goal blood pressure in the treatment of hypertension?".)


Major societies have published definitions of hypertension [5-7]. In general, hypertension was defined as a blood pressure ≥140/≥90 mmHg. However, subsequent trials have identified groups of patients at higher risk in whom goal blood pressures below this value may be associated with improved outcomes. (See 'Goal blood pressure' below.)


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Literature review current through: Sep 2016. | This topic last updated: Jan 20, 2015.
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