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Hypertension Do ABPM to confirm Dx before Rx (unless severe HTN)…
Hypertension
Do ABPM to confirm Dx before Rx
(unless severe HTN)
Malignant HTN
BP > 180/110 + papilloedema and/or retinal
haemorrhage
Controlled ↓ in BP over days to avoid stroke
Atenolol or long-acting CCB PO
Encephalopathy / CCF: fruse + labetalol / nitroprusside IV
Aim for 110 diastolic over ~4h
Antihypertensive Rx
Under 55
A: ACEi or ARB
e.g. lisinopril 10mg OD (↑ to 30-40mg)
e.g. candesartan 8mg OD (max 32mg OD)
over 55 or black
C: CCB: e.g. nifedipine MR 30-60mg OD
OR
D: Thiazide-like diuretic: e.g. chlortalidone 25-50mg OD
A + C (/D)
A + C + D
Resistant HTN
A+C+D+ consider further diuretic (e.g.
spiro) or α-blocker or β-B.
Seek expert opinion
In step 2, use ARB over ACEi in blacks.
Avoid thiazides + β-B if possible: ↑ risk of DM
Only consider β-B if young and ACEi/ARB not tolerated.
Lifestyle interventions
↑ exercise
↓ smoking, ↓ EtOH, ↓ salt, ↓ caffeine
CV Risk Mx
Statins for 1O prevention if 10yr CVD risk ≥20%
Aspirin may be indicated: evaluate risk of bleeding
Indications for Pharmacological Rx
<80yrs, stage 1 HTN (>140/90) and one of:
Target organ damage (e.g. LVH, retinopathy)
10yr CV risk ≥20%
Established CVD
DM
Renal disease
Anyone with stage 2 HTN (>160/100)
Severe / malignant HTN (specialist referral)
Consider specialist opinion if <40yrs with stage 1 HTN and no end organ damage
BP Targets
Under 80yrs: <140/90 (<130/80 in DM)
Over 80yrs: <150/90