Global Vascular Protection Therapy for Adults with Hypertension Without Compelling Indications for Specific Agents

1. Statin therapy is recommended in hypertensive patients with three or more cardiovascular risk factors as defined in Supplemental Table S11 (Grade A in patients older than 40 years), or with established atherosclerotic disease (Grade A regardless of age).
2. Consideration should be given to the addition of low dose acetylsalicylic acid (ASA) therapy in hypertensive patients ≥ 50 years (Grade B). Caution should be exercised if blood pressure is not controlled (Grade C).
3. Tobacco use status of all patients should be updated on a regular basis and health care providers should clearly advise patients to quit smoking (Grade C).
4. Advice in combination with pharmacotherapy (e.g., varenicline, bupropion, nicotine replacement therapy) should be offered to all smokers with a goal of smoking cessation (Grade C).
5. For high-risk patients (Table 3), aged ≥50 years, with systolic BP levels ≥130 mmHg, intensive management to target a systolic BP ≤120 mmHg should be considered. Intensive management should be guided by automated office BP measurements (see Diagnosis and Assessment Guidelines, Section I [Accurate measurement of BP], and Supplemental Table S2 [Recommended Technique for Automated Office Blood Pressure]). Patient selection for intensive management is recommended and caution should be taken in certain high-risk groups (Table 5; Grade B).