Hypertension Flashcards
First line treatment in patient age <55 and not of
black African or African– Caribbean family origin / With T2DM
ACEi or ARB
First line treatment in patient age >55 / Afro-caribbean
CCB
Second line treatment
Add ACEi or ARB if already added CCB
Add CCB if already added ACEi or ARB
OR thiazide-like duiretic
Third line treatment
ACEi or ARB + CCB + thiazide-like duiretic
Fourth line treatment
Confirm resistant hypertension: confirm elevated BP with ABPM or HBPM, check for postural hypotension and discuss adherence.
Consider seeking expert advice or adding a:
• low-dose spironolactone if blood potassium level is ≤4.5 mmol/l
• alpha-blocker or beta-blocker if blood potassium level is >4.5 mmol/l
Seek expert advice if BP is uncontrolled on optimal tolerated doses of 4 drugs
BP target age <80 years:
- Clinic BP <140/90 mmHg
* ABPM/HBPM <135/85 mmHg
BP target age ≥80 years:
- Clinic BP <150/90 mmHg
* ABPM/HBPM <145/85 mmHg
BP target postural hypotension:
• Base target on standing BP
BP target frailty or multimorbidity:
• Use clinical judgement
Measure standing and sitting BP in people
with:
- type 2 diabetes or
- symptoms of postural hypotension or
- aged 80 and over.
In BP under 140/90 mmHg
Check BP at least every 5 years and more
often if close to 140/90 mmHg
Treatment for age >80 with clinic BP >150/90 mmHg:
• Offer lifestyle advice and consider drug treatment
Treatment for age <80 with target organ damage, CVD, renal disease, diabetes or 10-year CVD risk ≥10% and with clinic BP >150/90 mmHg:
• Offer lifestyle advice and discuss starting drug treatment
Treatment for age <60 with 10-year CVD risk <10% and with clinic BP >150/90 mmHg:
• Offer lifestyle advice and consider drug treatment
Treatment for age <40 with clinic BP >150/90 mmHg:
• Consider specialist evaluation of secondary causes and assessment long term benefits and risks of treatment
