The benefits of blood pressure reduction have been clearly established for diastolic pressures of more than 100 mm Hg. For patients with a diastolic pressure between 90 and 99 mm Hg on repeated measurements, treatment should be initiated if other risk factors are present—for example, a family history of coronary risk, increased cholesterol level, male sex, smoking, or diabetes mellitus. When the pressure seems to be labile or exaggerated in the office, home or ambulatory readings may provide confirmatory information. For persons with diastolic pressures in the range of 90 to 94 mm Hg, it may be suitable to initiate therapy with nonpharmacologic maneuvers such as sodium restriction, weight reduction, and physical conditioning. In such cases, careful follow-up of blood pressure is particularly important because it may increase later. The initial therapy for mild hypertension should be selected to minimize adverse effects and should be tailored to the individual patient. Management of all levels of hypertension must be considered in light of the associated risk factors and a concomitant effort to minimize cardiovascular risk.
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