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Similarly, the ACC/AHA guidelines did not account for the increased harms of over-treatment in older adults. Michael LeFevre noted in an AFP editorial ( ), “It is an overreach to take the results of existing trial data and label everyone who has a BP above 130/80 mm Hg as having uncontrolled hypertension, particularly when that label will be applied on the basis of the most recent routine office BP measurement.” Although the ACC/AHA guidelines recommend that everyone diagnosed with hypertension be verified with home or 24-hour ambulatory monitoring, this service is not uniformly available. They move us away from the 2017 American College of Cardiology/American Heart Association (ACC/AHA ) guidelines, which recommended a diagnosis and treatment target of 130/80 mm Hg primarily based on a few large, well-controlled trials that are difficult to replicate in practice. Limit obesity, particularly truncal obesityĮditor's Note: The ISH guidelines are important because they successfully cut the Gordian knot of conflicting diagnosis thresholds and treatment targets in hypertension.

Smoking cessation programs and adjuncts are recommendedĭaily mindfulness or meditation appears to improve blood pressure measurementsĮvaluate obesity by waist-to-height ratio less than 0.5, or by ethnic-specific body mass index targets Limit consumption of high salt foods, including fast foods, processed foods, and soy sauce Moderate intensity aerobic activity (e.g., walking, jogging, cycling, yoga, swimming) at least 5 days per week Moderate consumption of coffee, and green and black teaĪdd strength or resistance training 2 to 3 days per week Reduce consumption of foods high in sugar, and saturated or trans fatsĬonsider hibiscus tea, pomegranate juice, beetroot juice, and cocoa Increase consumption of vegetables high in nitrites (e.g., leafy vegetables, beetroot)

Increase consumption of foods high in calcium, magnesium, and potassium (e.g., avocados, legumes, nuts, seeds, tofu)

Increase consumption of dairy, fruits, polyunsaturated fats, vegetables, and whole grains Limit to moderate daily consumption (i.e., 1.5 standard drinks per day for women and 2 for men)