Hypertension: Guideline on Management

Normal Blood Pressure: <120/<80 mm Hg - Promote Healthy lifestyle and measure BP annually

Elevated Blood Pressure: 120-129/<80 mm Hg- Start with non-pharmacologic therapy, reassess BP in 3-6 months

Stage 1 Hypertension: 130-139/80-89 mm Hg

ASCVD risk ( http://tools.acc.org/ASCVD-Risk-Estimator-Plus) >=10% - Start with both non pharmacologic and pharmacologic therapy. Reassess BP in 1 month. If at goal, reassess every 3-6 months. If not at goal, assess for adherence and consider intensification of therapy.                 

ASCVD risk < 10%- Start with nonpharmacologic therapy, reassess BP in 3-6 months. If not at goal consider initiation of pharmacologic therapy. 

Stage 2 Hypertension: ≥140/≥90 mm Hg- Start with both non pharmacologic and pharmacologic therapy. Reassess BP in 1 month. If at goal, reassess every 3-6 months. If not at goal, assess for adherence and consider intensification of therapy. 

For adults with hypertension requiring pharmacological treatment, any of the following three classes of pharmacological antihypertensive medications as an initial treatment:
1. Thiazide and thiazide-like diuretics agents
2. Angiotensin-converting enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs)
3. Long-acting dihydropyridine calcium channel blockers (CCBs)

Consider using diuretics or CCB in patients 65 years or older, or those of African or Afro-Caribbean descent; beta-blockers (BBs) post MI and ACEis/ARBs in those with diabetes, heart failure or CKD 

Basic laboratory tests : Renal function test, lipid profile, blood glucose, HbA1C, urine dipstick, and ECG

Target blood pressure treatment goal of <140/90 mmHg in all patients with hypertension without comorbidities; treatment goal of <130 mmHg in patients with hypertension and known cardiovascular disease (CVD), diabetes mellitus, chronic kidney disease

Consider monthly follow up after initiation or a change in antihypertensive medications until patients reach target. Follow up every 3–6 months for patients whose blood pressure is under control. 

Beginning treatment with two antihypertensive drugs from different classes is recommended when baseline BP is ≥20/10 mmHg above goal.

Monitor potassium and kidney function when starting or changing the dose of ACEi/ARB or thiazide/thiazide-like diuretic.

ACEI or ARB should not be given to pregnant women.