Hypertension

ClassificationSystolic DiastolicLifestyle
ModificationNormal<120and <80encouragePrehypertension120-
139Or 80-89YesStage 1 Htn140-159Or 90-100YesStage 2
Htn=/>160=/> 100YesDiabetic/Kidney DiseaseGoal BP <130Goal
BP <80Yes

Lifestyle Modifications
ModificationDrop in BP mmHgWeightlossLoss of 10kg5-20Decrease Sodium
Intake< 2.4gm per day2-8Decrease Alcohol Intakemales<2 per day, females <1
per day2-4Increase Physical Activity30 minutes per day4-9Diet Increase fruits,

Physical Exam veggies, decrease saturated fat8-14Smokingquit

BP check – 2 readings, both arms, at heart level
Fundoscopic Exam – annually
Calculate BMI kg/m2
Carotid Auscultation
Abdomen – check renal, femoral bruits, aortic pulsation
Thyroid palpation
Heart and Lung Exam
Edema
Neurologic Exam

Labs
ECG
Urinalysis
Fasting Lipid Profile
Serum Creatinine
Blood Glucose

Without Underlying Disease

Stage 1 or 2 Hypertension
Medication Table
With Underlying Disease
MedicineClassDoseFrequencyHydrochlorothiazide
Concomitant ConditionAntihypertensiveDon’t UseAnginaBB,
**1st line therapyDiuretic - K+ wasting25 mgODDitide
CCBPost MIBB, ACEI, Diuretics, LVHACEI, alpha blockerCCBHeart
(HCTZ/Triamterene)Diuretic – K+ sparing and wasting1 tabODLasilactone
FailureACEI, Diuretic,BB, ARB
(Lasix/Spironolactone)Diuretic- K+ sparing and wasting1 tabODEnalaprilACE
HydralazineAtrial Tachy/FibCCB –amilodipineRenal FailureACEI – if
I5mgOD/BDLosartanARB10mgODAmilodipineCa++ Ch Bl5mgODAtenololB
Cr<3, Loop DiureticsACEI if Cr >3, or K+ sparing DiureticsDiabetes
Blocker25 mgOD
MellitusACEI,, diuretic, ARBAsthma/COPDCCBBBDepressionACEI,
diureticsBBImpotenceACEI, alpha blocker, CCBBB

Optimal Blood Pressure Reached

Follow up in 3-6 months or for comorbiid conditions
Optimal Pressure Not Reached
Increase Drug to Maximum Dose
Then, Add a second Antihypertensive,
Two drug regimine should include a diuretic