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When drug therapy is needed, the guidelines recommend starting with slightly different medications depending on race. For nonblacks, including those with diabetes, it’s okay to start with an ACE inhibitor, angiotensin-receptor blocker, calcium-channel blocker, or thiazide-type diuretic. Among blacks, including those with diabetes, a calcium-channel block or thiazide-type diuretic is the best initial medication. Among individuals with declining kidney function, it’s best to start with a low dose of an ACE inhibitor or angiotensin-receptor blocker, since these types of medications help protect the kidneys from further damage.
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The previous set of blood pressure guidelines, published 10 years ago, were put together by a panel assembled by the National Heart, Lung, and Blood Institute (NHLBI), and carried the gravitas of a federal recommendation. The current panel was assembled by the NHLBI in 2008, but then was essentially cut loose when the institute announced it was getting out of the business of developing clinical practice guidelines.

The panel set out to base their guidelines only on data from randomized controlled trials, the gold standard of medical research. They openly acknowledged that this wasn’t possible, and instead had to base some of the recommendations on expert opinion. The recommendations are sure to draw criticism and create some controversy. To their credit, the panelists have said they would share all of the prepublication comments and communications between experts within and outside the panel.
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In a nutshell, here is what was recommended:

    Among adults age 60 and older with high blood pressure, aim for a target blood pressure under 150/90.
    Among adults age 30 to 59 with high blood pressure, aim for a target blood pressure under 140/90
    Among adults with diabetes or chronic kidney disease, aim for a target blood pressure under 140/90.
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The expert panel that put together the guidelines also weighed in on how best to get to these targets. It recommended that everyone with high blood pressure, as well as those in the gray zone between normal and high blood pressure, adopt healthy lifestyle changes known to control blood pressure. These include losing weight if necessary, limiting salt intake, eating a diet rich in fruits, vegetables, and whole grains, and keeping physically active.
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