Hypertension Update: Current Guidelines.

Hypertension affects at least 1 in 3 American adults and is a major contributor to premature mortality. Current guidelines recommend screening all adults for hypertension. Ambulatory blood pressure (BP) monitoring should be used to confirm the diagnosis of hypertension for most adults before starting antihypertensive drugs. Ambulatory BP monitoring is the preferred method but home BP monitoring is an acceptable alternative. Management of hypertension substantially reduces the risk of heart failure, stroke, and myocardial infarction. Recommended lifestyle modifications include weight loss for overweight or obese patients, regular exercise, the Dietary Approaches to Stop Hypertension (DASH) diet, reduced dietary sodium intake, and reduced alcohol intake. Most hypertensive patients will need at least two drugs to control BP. Although not endorsed by the American Academy of Family Physicians, recent guidelines from the American College of Cardiology and American Heart Association state that a BP level goal of less than 130/80 mm Hg for adults with confirmed hypertension and without additional markers of increased atherosclerotic cardiovascular disease (ASCVD) risk may be reasonable. Decisions regarding when to start antihypertensive drugs are based in part on cardiovascular risk.