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1.
Out of office (ambulatory) blood pressure measurements can be useful to confirm the diagnosis of hypertension, especially in patients with white coat hypertension (elevated blood pressure only in the clinician setting/office) and masked hypertension (elevated blood pressure only out of the clinician setting/office) [77], [78].
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2.
The American College of Cardiology/American Heart Association defines hypertension as ≥ 130/80 mmHg, with a treatment goal of <130/80 mmHg [77].
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3.
The European Society of Cardiology/European Society of Hypertension defines hypertension as ≥ 140/90 mmHg. Depending on clinical response and tolerability, the BP treatment goal is < 140/90 mmHg for everyone, < 130/80 mmHg in most patients, and 120–130/70-79 mmHg in patients with diabetes mellitus, CVD and stroke/transient ischemic attack. In patients with CVD, diastolic blood pressure should not be lowered to <70 mmHg (to avoid impairment of myocardial perfusion). For many older patients 65–80 years of age, the systolic blood pressure goal is 130–139 mmHg [78].
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4.
Hypertension is a major risk factor for CVD, which warrants more aggressive treatment of concomitant CVD risk factors (e.g., overweight or obesity, diabetes mellitus, dyslipidemia, cigarette smoking) [73].
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5.
Non-pharmacologic treatment of high blood pressure includes low-sodium diet (<2300 mg of sodium per day), adequate potassium intake, routine physical activity/exercise, attaining a healthy body weight, and no more than low to moderate alcohol intake [4], [80].
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6.
Single pill combination antihypertensive therapy is often recommended for initial therapy (i.e., angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker in same pill combination with a thiazide diuretic) [80,81] Sacubitril/valsartan is a combination neprilysin inhibitor/angiotensin receptor blocker that is a combination agent approved for the treatment of heart failure with reduced ejection fraction; it may also lower blood pressure [82].
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7.
Regarding diuretics, chlorthalidone is a thiazide-like diuretic with a longer half-life and often considered the preferred thiazide diuretic. Chlorthalidone reduces blood pressure more than hydrochlorothiazide, especially over a 24-h period of time, and has more robust data than hydrochlorothiazide to support reduction in CVD. Thiazide diuretics are a first-line therapy for hypertension. Loop diuretics (e.g., furosemide torasemide, bumetanide, azosemide may be preferred in patients with heart failure (especially torasemide) and when estimated glomerular filtration rate is < 30 ml/min [77,83,84].
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8.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) are first line antihypertensive agents. In addition to lowering blood pressure, ACE inhibitors and ARBs are beneficial in treating heart failure and coronary artery disease. ACE inhibitors and ARBs should not be used together and should not be used in combination with direct renin inhibitors (i.e., aliskiren), largely due to questionable added benefits, and potential for hyperkalemia [77].
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9.
Calcium channel blocker (CCBs) may help treat angina and cardiac dysrhymias; however, dihydropyridine CCBs (e.g., amlodipine, nifedipine) may cause edema and non-dihydropyridine CCB (e.g., verapamil and diltiazem) may cause bradycardia and heart block and should be avoided in patients with heart failure with reduced ejection fraction. CCB’s lower blood pressure and are first line antihypertensive agents [77].
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10.
Beta blockers treatment reduce CVD in patients with reduced ejection fraction, are used to treat angina pectoris and cardiac dysrhythmias, and may reduce the risk of recurrent myocardial infarction after an acute myocardial infarction. However, the blood pressure lowering may be less than other anti-hypertensive drug treatments [85,86].
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