HYPERTENSION:

A CLINICAL PATHWAY
PRESENTATION
PRESENTED BY: LANCE SABER TOLEDO MD
WHAT IS HYPERTENSION?

 SYSTOLIC PRESSURE CONSISTENTLY >140 mmHG or

 DIASTOLIC PRESSURE > 90 mmHG in multiple readings.
 BLOOD READINGS SHOULD BE TAKEN ON TWO SEPARATE
OCCASSIONS AT LEAST ONE WEAK APART
HYPERTENSION

 HYPERTENSION IS A MAJOR RISK FACTOR FOR CARDIOVASCILAR DISEASE. WORLDWIDE, IT

IS ESTIMATED THAT HALF OF DEATHS DUE TO TRKE AND HEART DISEASE ARE CAUSSED BY
HYPERTENSION
OBJECTIVES

 GENERAL
 TO IMPROVE OUTCOMES OF PATIENTS WITH HYPERTENSION SEEN IN FAMILY
AND COMMUNITY PRACTICE
 SPECIFIC
 TO IMPROVE QUALITY OF CARE
 TO STANDARDIZED QUALITY OF CARE AMONG PHYSICIANS IN A FAMILY
AND COMMUNITY PRACTICE
“BLOOD PRESSURE MEASUREMENTS SHOULD BE TAKEN IN

ALL PATIENTS CONSULTING IN A FAMILY OR COMMUNITY CLINIC”

CLINICAL PATHWAYS
FIRST VISIT

 ALL PATIENT SHOULD BE SCREENED FOR ELEVATED BP WITH

APPROPRIATE BP MEASUREMENT (A-III)
FIRST VISIT

 THOROUGH HISTORY FOCUSING ON SYMPTOMS

 FAMILY HX USING GENOGRAMS
 SMOKING HISTORY
 OTHER CO-EXISTING CHRONIC DISEASES (A-II)
 THOROUGH PE FOCUSING ON
 BMI
 WAIST/HIP RATIO
 FUNDOSCOPY, NEUROLOGICAL, CARDIAC, RENAL AND PERIPHERAL ARTERIES (A-II)
INITIAL BP PATHWAY DIAGNOSTICS/ PHARMACOLOGI NON-PHARMA PATIENT
DECISION LABORATORIES C INTERVENTION OUTCOMES
INTERVENTIONS S
≥140/90 REFER TO
HOSPITAL
*EMERGENCY
REFERRAL
EDUCATE THE
PATIENT (A-I)
AWARE OF INITIAL
DIAGNOSIS (A-III)
(A-III)
SINGLE DOSE OF EXPLAIN THE
WITH S/SX OF END MEDICATIONS (A-I) AWARE OF RISK
ORGAN DAMAGE ANTI FACTORS AND
HYPERTENSIVE LIFESTYLE COMPLICATIONS
PRIOR TO MODIFICATIONS (A-I) (A-III)
TRANSPORT (A-I)
AWARE OF
IMPORTANCE OF
≥180/110 START
MEDICATIONS
12L ECG, UA, FBS, START MEDICATIONS
WITH MONO OR
INQUIRE AND
RECOMMEND ADERENCE TO
CREATININE, COMBINATION OF FAMILY LIFESTYLE DIAGNOSTICS AND
(A-III) SERUM K, LIPID ANTI HYPERTENSIVE, ACTIVITES (A-I) INTERVENTIONS
PROFILE DEPENDING ON CO- (A-III)
IF WITH CO-
≥140/90 MORBIDS, (B-II) MORBIDITIES OR SIDE
EFFECTS (A-I)
INQUIRE FOR
COMMUNITY
WITH PREVIOUS REFER TO LIFESTYLE
HISTORY OF ACTIVITES (A-III)
ELEVATED BP SPECIFIC
PATHWAY FOR
MANAGEMENT
(A-II)

≥140/90 BP MONITORING
OR 2ND VISIT
NO FOLLOW UP AFTER 1-
2 WEEKS
WITH NO HX OF MEDICATIONS (A-II)
AFTER 4 WEEKS (A-III)
ELEVATED BP OFFER FAMILY
WELLNESS PACKAGE
(A-III)
SECOND VISIT

 REVIEW AND NOT ANY CHANGES IN HISTORY AND PE (A-II)

 REVIEW BP MONITORING (A-II)
 REVIEW DIAGNOSTICS AND ESTABLISH PRESENCE OF CO-MORBIDITIES (A-II)
REPEAT BP PATHWAY DIAGNOSTICS/ PHARMACOLOGI NON-PHARMA PATIENT
DECISION LABORATORIE C INTERVENTION OUTCOMES
S INTERVENTIONS S
ENHANCE /REVISE AFTER 6-12 CONTINUE / REVISE ENHANCE EDUCATION IMPROVED BP
PHARMACOLOGIC CONTINUE/REVISE MEDICATIONS WITH ABOUT HYPERTENSION CONTROL
MONTHS MONO OR (A-I)
AND NON- MEDICATIONS 18 – 59 Y/O
COMBINATION OF ANTI
PHARMACOLOGIC HYPERTENSIVE, EXPLAIN THE <140/80
INTERVENTIONS IF WITH CO- REPEAT
DEPENDING ON CO- MEDICATIONS (A-I)
UNTIL BP CONTROL MORBIDS, REFER TO MORBIDITIES OR SIDE >60 Y/O
IS ACCHIEVED SPECIFIC PATHWAY 12L ECG, UA, FBS, EFFECTS (A-I) ENHANCE ADVICE ON <150/90 (A-II)
(A-III) FOR MANAGEMENT CREATININE, LIFESTYLE
MODIFICATIONS (A-I) BMI
(A-II) SERUM K, LIPID 18.5 – 24.9 (A-II)
18 – 59 Y/O PROFILE
<140/80
(B-II) ENHANCE MODIFICATION OF RISK
RECOMMENDATION FOR FACTORS (A-II)
>60 Y/O APPROPRIATE FAMILY
<150/90 (A-II) LIFESTYLE ACTIVITES
(A-I)

ENHANCE ABSENCE OF NEW

RECOMMENDATION TO COMPLICATIONS (A-III)
PARTICIPATE IN
COMMUNITY LIFESTYLE
ACTIVITES (A-III)

FF UP AFTER 1 MONTH, ADHERENCE TO THE

UNTIL BP TARGET IS DIAGNOSTICS AND
REACHED, THEN EVERY INTERVENTONS (A-II)
3-6 MONTHS IF TARGET
IS REACHED (A-III)

ADHERENCE TO THE
AGREED PLAN (A-III)
CONTINUING VISIT

 REVIEW AND NOT ANY CHANGES IN HISTORY AND PE (A-II)

 REVIEW BP MONITORING (A-II)
 REVIEW DIAGNOSTICS AND ESTABLISH PRESENCE OF CO-MORBIDITIES (A-II)
REPEAT BP PATHWAY DECISION DIAGNOSTICS/ PHARMACOLOGIC NON-PHARMA PATIENT
LABORATORIES INTERVENTIONS INTERVENTIONS OUTCOMES
IF HOME BP OR SECOND 12L ECG, UA, FBS, START MEDICATIONS ENHANCE EDUCATION IMPROVED BP CONTROL
VISIT BP WITH MONO OR ABOUT HYPERTENSION (A- 18 – 59 Y/O
CREATININE, SERUM COMBINATION OF ANTI I) <140/80
≥140/90 START MEDICATIONS
K, LIPID PROFILE HYPERTENSIVE,
DIAGNOSE AS (A-III)
HYPERTENSION (A-II) (B-II) DEPENDING ON CO- EXPLAIN THE >60 Y/O
MORBIDITIES OR SIDE MEDICATIONS (A-I) <150/90 (A-II)
IF WITH CO-MORBIDS,
EFFECTS (A-I)
REFER TO SPECIFIC ENHANCE ADVICE ON
PATHWAY FOR LIFESTYLE
MANAGEMENT (A-II) BMI
MODIFICATIONS (A-I) 18.5 – 24.9 (A-II)

ENHANCE MODIFICATION OF RISK

RECOMMENDATION FOR FACTORS (A-II)
APPROPRIATE FAMILY
LIFESTYLE ACTIVITES (A-
I)

IF HOME BP OR SECOND ENHANCE ABSENCE OF NEW

VISIT BP RECOMMENDATION TO COMPLICATIONS (A-III)
<140/90 PARTICIPATE IN
RULE OUT COMMUNITY LIFESTYLE
HYPERTENSION, ACTIVITES (A-III)
MONITOR AFTER 6-12
MONTHS (A-III)
FF UP AFTER 1 MONTH, ADHERENCE TO THE
UNTIL BP TARGET IS DIAGNOSTICS AND
REACHED, THEN EVERY 3- INTERVENTONS (A-II)
6 MONTHS IF TARGET IS
REACHED (A-III)

ADHERENCE TO THE
AGREED PLAN (A-III)
THANK YOU