The Agency for Healthcare Research and Quality is a division of the U.S. Department of Health and Human Services. This agency reviews and approves clinical guidelines and recommendations. The clinical guidelines approved by AHRQ for hypertension were researched by Kaiser Permanente. They apply to adults between the ages of 19 and 79 who are not pregnant and who do not have diabetes, heart failure, renal insufficiency or known cardiac disease.
Guidelines
The clinical guidelines cited by the AHRQ define hypertension by looking to a person's systolic and diastolic blood pressures. According to MayoClinic.com, the systolic pressure refers to the pressure in the arteries when the heart beats. The diastolic pressure refers to the pressure in the arteries between beats.
According to the AHRQ, normal systolic pressure is under 120 and a normal diastolic pressure is under 80.
Prehypertension involves a systolic pressure between 120 and 139 or a diastolic pressure between 80 and 89.
Stage 1 hypertension involves a systolic pressure between 140 and 159 or a diastolic pressure between 90 and 99.
Stage 2 hypertension involves a systolic pressure over 160 or a diastolic pressure over 100.
Treatment
Pharmacological treatment is not recommended for patients with prehypertension. The clinical guidelines set by the AHRQ recommend monitoring for two months before initiating treatment for patients with stage 1 hypertension. This monitoring period is reduced to one month for patients with stage 2 hypertension if the systolic pressure is under 179 or the diastolic pressure is under 109. If the pressures are higher than this, the ARHQ recommends treating immediately.
Recommended Drug Guidelines
The AHRQ notes that treating blood pressure often requires multiple medications. It have specific guidelines as to what order different types of drugs should be introduced to achieve the desired result.
The AHRQ recommends starting with a thiazide-type diuretic. If this is not sufficient, it recommends adding some type of ACE inhibitor.
If the thiazide and ACE inhibitor combo is not sufficient, the AHRQ recommends adding a beta blocker.
If the thiazide, ACE inhibitor and beta blocker combo is not sufficient, the AHRQ recommends adding a calcium channel blocker.
Thiazides, ACE inhibitors, beta blockers and calcium channel blockers all work very differently to lower blood pressure.
Behavioral Guidelines
The AHRQ recommends a moderately low-sodium, low-fat diet with lots of fruits and vegetables. Weight control is recommended for patients as well as limiting alcohol consumption to one daily drink for women and two daily drinks for men. Exercise such as 30 minutes of walking at least three times a week is also recommended.
Other Guidelines
The AHRQ also has guidelines for concomitant therapy for hypertension. Concomitant therapy involves measures other than behavioral changes or blood pressure medications.
81mg of daily aspirin is recommended for patients 50 to 80 to reduce heart and circulatory risks. Statins are not recommended in the absence of other risk factors.
