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Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke, heart failure, kidney failure and myocardial infarction. Evidence suggests that a reduction of blood pressure by 5 mmHg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21%.
For most people, recommendations are to reduce blood pressure to less than or equal to somewhere between 140/90 mmHg and 160/100 mmHg. [2] In general, for people with elevated blood pressure, attempting to achieve lower levels of blood pressure than the recommended 140/90 mmHg will create more harm than benefits, [3] in particular for older people. [4]
Lifestyle changes, including reducing dietary salt, increasing exercise and losing weight can help to reduce blood pressure. [9] Thiazides and thiazide-like diuretics have been in constant use since their introduction in 1958. Decades as a cornerstone of hypertension treatment show how well these drugs perform for most patients. [10]
with kidney transplant <120 SBP <130/80 CKD: ACEI/ARB Kidney transplant: ARB or CCB ISH 2020 [8] General Age <65 Age ≥65 <140/90 (reduction by at least 20/10) <130/80 <140/90 BP >140/90 and low-risk for CVD: Lifestyle changes BP >140/90 and CVD risk factors or failed lifestyle changes: monotherapy with thiazide-type diuretic, ACEI/ARB, and/or CCB
The effect of treatment of blood pressure between 130/80 mmHg and 160/100 mmHg is less clear, with some reviews finding benefit [6] [16] [17] [18] and others finding unclear benefit. [19] [20] High blood pressure affects 33% of the population globally. [9] About half of all people with high blood pressure do not know that they have it. [9]
Chlortalidone is considered a first-line medication for treatment of high blood pressure. [2] Some recommend chlortalidone over hydrochlorothiazide. [1] [15] A meta-analysis of randomized controlled trials found that chlortalidone is more effective than hydrochlorothiazide for lowering blood pressure, while the two drugs have similar toxicity.