How should you treat the newly diagnosed hypertensive patient?
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All hypertensive patients can potentially benefit from lifestyle interventions, including weight reduction, aerobic physical activity, the dietary approaches to stop hypertension (DASH) diet, and moderation of alcohol use (strength of recommendation [SOR]: A, systematic reviews). Although lifestyle interventions are effective for some patients, they haven't been proven to provide long-term control and don't lower blood pressure as much as medications (SOR: B, systematic review of inconsistent randomized controlled trial [RCT]). For specific high-risk patients, pharmacologic therapy is recommended at the time of diagnosis (SOR: C, expert opinion). When considering lifestyle changes and medication, it's important to assess patient preferences as well as overall cardiovascular risks, presence of target organ damage, and clinical cardiovascular disease, because lifestyle modification and medication can both affect quality of life (SOR: C, expert opinion).
Journal of Family Practice, 59(11) 2010: 651-653.