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Task 3: How will you make your treatment decision for Hypertension? -…
Task 3:
How will you make your treatment decision for Hypertension?
Blood pressure reading
Under 135/85 mmHg
Check BP at least every 5 years and more often if clinic BP close to 140/90 mmHg
• If evidence of target organ damage, consider alternative causes
Under 145/90 mm Hg
Check BP at least every 5 years and more often if close to 140/90 mmHg
135/85 to 149/94 mmHg
(Stage 1)
Age <80 with target organ damage, CVD, renal disease, diabetes or 10-year CVD risk ≥10%:
Offer lifestyle advice and discuss
starting drug treatment
Age <60 with 10-year CVD risk <10%:
Offer lifestyle advice and consider drug treatment
Age <40:
Consider specialist evaluation of secondary causes and assessment long- term benefits and risks of treatment
150/95 mmHg or more
(Stage 2)
• Offer ABPM (or HBPM if ABPM is declined or not tolerated)
• Investigate for target organ damage
• Assess cardiovascular risk
180/120 mmHg or more
Assess for target organ damage as soon as possible:
If target organ damage, consider starting drug treatment immediately without ABPM/HBPM
• If no target organ damage, confirm diagnosis by:
repeating clinic blood pressure measurement within 7 days, or
– considering monitoring using ABPM/ HBPM and ensuring a clinical review within 7 days
Refer for same-day specialist review if:
retinal haemorrhage or papilloedema
(accelerated hypertension) or life-threatening symptoms or suspected pheochromocytoma
It depends on: 1. Blood pressure reading 2. Age 3. Co morbidities
Choice of anti hypertensive based on co morbidities
HTN + Diabetes
ACEi or ARB
ACEi or ARB + CCB or thiazide-like diuretic
ACEi or ARB + CCB + thiazide-like diuretic
Confirm resistant hypertension, Consider seeking expert advice or adding a: alpha-blocker or beta-blocker if blood potassium level is >4.5 mmol/l, low-dose spironolactone4 if blood potassium level is ≤4.5 mmol/l . Seek expert advice if BP is uncontrolled on optimal tolerated doses of 4 drugs,
HTN without diabetes
Age <55 and not of black African or African– Caribbean family origin
Age 55 or over, Black African or African–Caribbean family origin (any age)
CCB
CCB + ACEi or ARB or thiazide-like diuretic