How to Effectively Lower Blood Pressure: Modern Approaches to Hypertension Treatment

Introduction

Hypertension, or high blood pressure, is one of the most common chronic conditions that significantly increases the risk of developing severe complications. Uncontrolled high blood pressure is a key factor in the development of heart failure, both through thickening of the left ventricular walls and impairment of its diastolic function, and by accelerating atherosclerosis and myocardial infarction, ultimately leading to systolic dysfunction [2]. Effective treatment of hypertension can prevent more than 50% of heart failure cases [2]. Therefore, understanding modern approaches to lowering blood pressure and managing hypertension is critical for preserving health and quality of life.

Blood Pressure Targets: Modern Guidelines

Achieving optimal blood pressure levels is crucial for preventing cardiovascular events and the progression of kidney disease [1]. In recent years, there has been a shift in understanding blood pressure targets. The SPRINT (Systolic Blood Pressure Intervention Trial) study demonstrated that lowering systolic blood pressure (SBP) to 120 mm Hg significantly reduces the frequency of cardiovascular events [1]. As a result, a lower target SBP level was adopted in the 2021 KDIGO (Kidney Disease: Improving Global Outcomes) guidelines [1].

However, the question of intensive SBP control to levels below 120 mm Hg in patients with chronic kidney disease (CKD) remains a subject of debate. Some data indicate that such an aggressive approach may be associated with an increased risk of adverse renal outcomes, especially in patients with advanced stages of CKD [1]. Currently, there are no randomized controlled trials dedicated exclusively to this patient group [1].

Pharmacological Treatment of Hypertension: Main Drug Classes

The choice of drug therapy depends on the patient's individual characteristics, the presence of comorbidities, and drug tolerance. Over the past decades, numerous studies have confirmed the efficacy of various classes of antihypertensive agents in preventing complications.

Traditionally, beta-blockers combined with diuretics have shown high efficacy in preventing the development of heart failure [2]. Modern comparative studies also confirm that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are effective in preventing heart failure [2]. However, calcium channel blockers appear to be less effective in preventing the development of heart failure in patients with hypertension [2].

For patients with heart failure following acute myocardial infarction, the combination of sacubitril/valsartan (ARNI) with cardiac rehabilitation has shown significant improvement in cardiorespiratory function and cardiac remodeling, including an increase in left ventricular ejection fraction [6].

Hypertension and Comorbidities: Special Approaches

Hypertension management is often complicated by the presence of other conditions requiring special attention:

• Chronic Kidney Disease (CKD): Uncontrolled blood pressure in patients with CKD can lead to serious adverse outcomes, including cardiovascular events and end-stage renal disease [1]. All CKD guidelines recommend measuring the estimated glomerular filtration rate (eGFR) to detect the disease, and some also advise using serum creatinine and urine dipstick testing [4].
• Atopic Dermatitis: A systematic review and meta-analysis showed that atopic dermatitis is associated with a higher likelihood of developing hypertension compared to healthy individuals [3]. This highlights the need for a comprehensive approach to patients with this skin condition.
• Heart Failure: As already mentioned, hypertension is the primary cause of heart failure [2]. Effective treatment of hypertension significantly reduces the risk of its onset.
• Pediatric Hypertension: High blood pressure in childhood is a major risk factor for hypertension and cardiovascular disease in adulthood [7, 8]. Despite clear guidelines, screening remains insufficient [8]. Diagnosis can be challenging due to frequent false-positive readings from single measurements, so multiple visits are required to confirm the diagnosis [8]. In overweight and obese children, hypertension may be underestimated by up to 20% [8]. Specific BP targets exist for adolescents, children with CKD, and type 1 diabetes mellitus [8].

Lifestyle and Prevention: Non-Pharmacological Methods

Lifestyle modifications play a key role in both the prevention and treatment of hypertension:

• Salt Restriction: High salt intake is a risk factor for cardiovascular disease [8]. Given the increasing consumption of processed foods, salt restriction is beneficial for the general population, especially children [8].
• Diet: Some studies suggest that consuming garlic (approximately half a clove to a clove per day) may lower cholesterol levels [5], which indirectly affects cardiovascular health. In general, a balanced diet rich in fruits, vegetables, and whole grains, along with limiting saturated fats and sugar, forms the foundation of a healthy lifestyle.
• Physical Activity: Regular moderate exercise helps lower blood pressure and improves overall cardiovascular health.
• Maintaining a Healthy Weight: Overweight and obesity are significant risk factors for hypertension [8]. Weight loss can substantially improve BP metrics.

The Importance of Early Diagnosis and Control

Early detection and adequate management of hypertension, especially in childhood, are crucial for preventing serious future complications [7, 8]. Regular blood pressure screening, particularly in risk groups, and confirming the diagnosis based on multiple measurements rather than a single reading are the foundation of an effective strategy [8].

References

1. Kim, S. G., & Lee, H. S. (2021). Blood pressure control in patients with chronic kidney disease. The Korean journal of internal medicine. https://pubmed.ncbi.nlm.nih.gov/34153181/
2. Canada, A. (2004). From hypertension to heart failure. Journal of clinical hypertension (Greenwich, Conn.). https://pubmed.ncbi.nlm.nih.gov/15470294/
3. Kim, H. O., et al. (2022). Association between atopic dermatitis and hypertension: a systematic review and meta-analysis. The British journal of dermatology. https://pubmed.ncbi.nlm.nih.gov/34319589/
4. Chan, M. R., et al. (2013). Prevention, detection, and management of early chronic kidney disease: a systematic review of clinical guidelines. Nephrology (Carlton, Vic.). https://pubmed.ncbi.nlm.nih.gov/23815515/
5. (1994). Cardiovascular diseases. JAMA. https://pubmed.ncbi.nlm.nih.gov/8182837/
6. Wang, H., et al. (2025). Clinical efficacy of sacubitril/valsartan combined with cardiac rehabilitation in patients with heart failure after acute myocardial infarction: a single-center randomized trial. BMC cardiovascular disorders. https://pubmed.ncbi.nlm.nih.gov/40175938/
7. Flynn, J. T., et al. (2019). Management of high blood pressure in children: similarities and differences between US and European guidelines. Pediatric nephrology (Berlin, Germany). https://pubmed.ncbi.nlm.nih.gov/29594504/
8. Jones, D. P., et al. (2018). What is new in paediatric hypertension? Archives of disease in childhood. https://pubmed.ncbi.nlm.nih.gov/28818842/

The information provided in this article is for reference purposes only and cannot replace an in-person consultation with a qualified medical specialist. Always consult a physician for diagnosis and treatment.