HYPERTENSION

Normal BP: <120/<80

Elevated BP: 120-129/<80
Stage 1 Hypertension: 130-139/80-89
Stage 2 Hypertension: ≥140/≥90

Recommended Laboratory Tests: CBC, Urinalysis, Potassium, FBS, Creatinine, Calcium, Total Cholesterol,
HDL, LDL, Triglycerides, ECG

Rule out correctable and secondary causes of hypertension first.

 These include drug-induced hypertension, thyroid or parathyroid disease, chronic disease,

renovascular disease, coarctation of the aorta, primary aldosteronism, chronic steroid therapy
and Cushing’s syndrome, and pheochromocytoma.

Encourage Lifestyle Change for Essential Hypertension

 Stop Smoking
 Lose weight if overweight. Maintain body mass index of 18.5 – 24.9 kg/m^2 for every 10
kilogram of weight loss, BP drops by approximately 5-20 mm Hg.
 Reduce sodium intake (< 2 gm of sodium or approximately < 6 gm of sodium chloride).
 Healthy diet. Consume a diet rich in vegetables, fruits and low fat dairy products. Reduce dietary
saturated fat and cholesterol intake for overall cardiovascular health. Reducing fat intake also
helps reduce calorie intake, which is important for control of weight in type II diabetes
 Engage in regular aerobic exercise once BP is controlled. At least 30 minutes per day, most days
of the week. Brisk walking is good exercise.
 Limit alcohol intake to less than 1 oz/day of ethanol (24 oz of beer, 8 oz of wine, or 2 oz of 80-
proof whiskey)
 Maintain adequate dietary potassium, calcium and magnesium intake.

Choice of Antihypertensive Drags Based on Patient Characteristics

 Diabetic patients and those with chronic kidney disease: Use ace-inhibitors or angiotensin II
antagonists to delay diabetic nephropathy.
 Young patients: Use beta-blockers unless contraindicated.
 Coronary artery disease patients: Use beta-blockers, calcium-antagonists. Avoid hydralazine.
 Heart failure patients: Use ACE-inhibitors and/or diuretics. Generally avoid beta-blockers and
calcium-antagonists.
 Athletes: Avoid beta-blockers and diuretics.
 Broncho-pulmonary disease patients: Use Verapamil and other calcium-antagonists. Avoid beta-
blockers.
 Peripheral vascular disease patients: Use calcium-antagonist (nifedipine), vasodilators, or ace-
inhibitors. Avoid beta-blockers.
 Dyslipidemic patients: Avoid beta-blockers and diuretics.
 End-stage renal disease patients: Use calcium-antagonists, diuretics and centrally-acting agents.
Caution on ace-inhibitors.
  For stroke patients: Use ACE-inhibitors and/or diuretics.
 Elderly patients: Use diuretics. Generally use lower dosages. Be wary of pseudohypertension
wherein the elevated BP is due to brachial artery atherosclerosis and not hypertension per se.

HYPERTENSIVE EMERGENCY AND URGENCY

Hypertensive Urgency: BP ≥180/≥120. No end organ damage; try oral medications first. Lower BP
within 2-3 days.
Hypertensive Emergency: BP ≥180/≥120. Presence of changes in sensorium, papilledema, or heart
failure. Use IV drugs stat. Lower BP within 24 hours.

Diet: NPO temporarily until stable

VS: BP q 15 minutes till stable

Diagnostics: CBC, Creatinine, K, ECG, Urinalysis, Chest X-ray, Fundoscopy

Therapeutics:

 Per Orem or Sublingual Treatment:

o Nifedipine (Calcibloc): 5-10 mg SL or PO (bite and swallow punctured capsule), repeat as
needed q 30 minutes, then 5-10 mg PO or SL q 6-8 hr. or Calcibloc OD 30 mg PO OD-BID.
Maximum dose is 90 mg/day, contraindicated in patients with AMI or Unstable Angina.
o Captopril (Capoten): 25 mg 1/2 -1 tab SL or PO q 30 mins as needed.
o Clonidine: 75 mcg tab SL or PO q hr (Maximum of 700 mcg)
 Intravenous Treatment:
o Nicardipine IV: Duration of action: 3-6 hr
 D5W 250 ml + Nicardepine 20 mg
 Concentration = 0.08 mg/ml
 Drip of 15-67 ugtts/min is equivalent to 1-5 mg/hr
o Hydralizine (Apresoline) IV: 5-10 mg IV q 3-6 hr (0.1-0.5 mg/kg/dose; maximum of 20 mg
per dose), or give 25-50 mg PO Qid. Duration of action: 3-6 hr.
o Isosorbide dinitrate IV (especially for patients with concomitant CAD)
 D5W 90 ml+ Isoket 10 mg in a soluset
 Drip of 10-50 ugtts/min is equivalent to 1-5 mg/hr.
o Clonidine (Catapres) IV: May give 1 amp (150 mcg/I ml amp) SC, IM or IV with patient
supine.
o Nitroprusside IV (not available): 0.25-10 mcg/kg/min IV (50 mg in D5W 250ml), titrate to
o desired BP using an infusion set.