Recommendations for Adults With High Blood Pressure or Hypertension

Referenced studies that support recommendations are summarized in Online Data Supplements 13 and 14.

COR	LOE	RECOMMENDATIONS
I	A	1. In adults with elevated blood pressure (BP) or hypertension, including those requiring antihypertensive medications nonpharmacological interventions are recommended to reduce BP. These include: weight loss (S4.4-2–S4.4-5); a heart-healthy dietary pattern (S4.4-6–S4.4-8); sodium reduction (S4.4-9–S4.4-13); dietary potassium supplementation (S4.4-14–S4.4-18); increased physical activity with a structured exercise program (S4.4-3, S4.4-5, S4.4-11,S4.4-19–S4.4-23); and limited alcohol (S4.4-24–S4.4-29). Adapted from recommendations in the 2017 Hypertension Clinical Practice Guidelines (S4.4-1).
I	SBP: A	2. In adults with an estimated 10-year ASCVD risk* of 10% or higher and an average systolic BP (SBP) of 130 mm Hg or higher or an average diastolic BP (DBP) of 80 mm Hg or higher, use of BP-lowering medications is recommended for primary prevention of CVD (S4.4-30–S4.4-38). Adapted from recommendations in the 2017 Hypertension Clinical Practice Guidelines (S4.4-1).
	DBP: C-EO
I	SBP: B-RSR	3. In adults with confirmed hypertension and a 10-year ASCVD event risk of 10% or higher, a BP target of less than 130/80 mm Hg is recommended (S4.4-33,S4.4-39–S4.4-42). Adapted from recommendations in the 2017 Hypertension Clinical Practice Guidelines (S4.4-1).
	DBP: C-EO
I	SBP: B-RSR	4. In adults with hypertension and chronic kidney disease, treatment to a BP goal of less than 130/80 mm Hg is recommended (S4.4-43–S4.4-48). Adapted from recommendations in the 2017 Hypertension Clinical Practice Guidelines (S4.4-1).
	DBP: C-EO
I	SBP: B-RSR	5. In adults with T2DM and hypertension, antihypertensive drug treatment should be initiated at a BP of 130/80 mm Hg or higher, with a treatment goal of less than 130/80 mm Hg (S4.4-33, S4.4-47, S4.4-49–S4.4-54). Adapted from recommendations in the 2017 Hypertension Clinical Practice Guidelines (S4.4-1).
	DBP: C-EO
I	C-LD	6. In adults with an estimated 10-year ASCVD risk <10% and an SBP of 140 mm Hg or higher or a DBP of 90 mm Hg or higher, initiation and use of BP-lowering medication are recommended (S4.4-36,S4.4-55–S4.4-58). Adapted from recommendations in the 2017 Hypertension Clinical Practice Guidelines (S4.4-1).
IIb	SBP: B-NR	7. In adults with confirmed hypertension without additional markers of increased ASCVD risk, a BP target of less than 130/80 mm Hg may be reasonable (S4.4-59–S4.4-62). Adapted from recommendations in the 2017 Hypertension Clinical Practice Guidelines (S4.4-1).
	DBP: C-EO

^*ACC/AHA pooled cohort equations to estimate 10-year risk of ASCVD.