HYPERTENSION: Edited by Hector O. Ventura and Carl J. LavieNew wrinkles in hypertension management 2022Carey, Robert M.a; Whelton, Paul K.b Author Information aDivision of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia bDepartments of Epidemiology and Medicine, Tulane University, New Orleans, Louisiana, USA Correspondence to Robert M. Carey, MD, P.O. Box 801414, University of Virginia Health System, Charlottesville, VA 22908-1414, USA. Tel: +1 434 924 5510; fax: +1 434-982-3626; e-mail: [email protected] Current Opinion in Cardiology: July 2022 - Volume 37 - Issue 4 - p 317-325 doi: 10.1097/HCO.0000000000000980 Buy Metrics Abstract Purpose of review High blood pressure (BP) is the world's leading risk factor for cardiovascular disease (CVD) and death. This review highlights findings during the past 18 months that apply to the management of high BP in adults in the context of the 2017 American College of Cardiology/American Heart Association (AHA) BP guideline. Recent findings A comprehensive meta-analysis of clinical trials that employed a novel statistical method identified a substantially linear relationship between dietary sodium intake and BP, strongly supporting the AHA daily dietary sodium intake recommendation of less than 1500 mg/day but suggesting that any reduction in sodium intake is likely to be beneficial. Among adults with hypertension, use of a salt substitute (containing reduced sodium and enhanced potassium) led to striking reductions in CVD outcomes. Young adults with stage 1 hypertension and a low 10-year atherosclerotic CVD risk score should be started on a 6-month course of vigorous lifestyle modification; if their BP treatment goal is not achieved, a first-line antihypertensive agent should be added to the lifestyle modification intervention. In patients with stage 4 renal disease, the thiazide-like diuretic chlorthalidone (as add-on therapy) lowered BP markedly compared with placebo. Nonsteroidal mineralocorticoid receptor antagonists (MRAs) represent a new class of MRA that has been shown to lower BP and provide significant CVD protection. In Chinese adults aged 60–80 years at baseline, intensive BP control with a SBP target of 110–129 compared with 130–149 mmHg reduced CVD events with minimal side effects. Summary Recent findings have advanced our knowledge of hypertension management, clarifying, amplifying and supporting the 2017 ACC/AHA BP guideline recommendations. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.