What is the recommended first line of treatment for hypertension in older adults?

Lifestyle modifications are indeed recognized as the foundational approach for managing hypertension, particularly in older adults. These modifications include dietary changes, such as adopting a low-sodium diet, increasing physical activity, reducing alcohol intake, and managing stress. They can often lead to significant improvements in blood pressure and overall health status without the immediate need for pharmacotherapy.

This approach is especially critical in older adults, who may have unique responses to medications and a higher likelihood of polypharmacy due to comorbidities. Beginning with lifestyle changes can provide a non-invasive way to control blood pressure and can often reduce the need for medications altogether, or at least minimize the dosage and potential adverse effects associated with pharmacological treatments.

While medications like diuretics, calcium channel blockers, and ACE inhibitors are effective treatments for hypertension and often used in practice, particularly when lifestyle modifications do not achieve adequate control, the emphasis on non-pharmacological interventions as the first line reflects a comprehensive understanding of patient care, prioritizing safety and holistic management.