Professional Documents
Culture Documents
Step
1 Assess ALGORITHM Step BP TARGETS
8 • <140/90 mmHg
Major risk factors Step Measure Blood Pressure • <150/90 mmHg if >
according to SAHS guidelines* 80 years
•Levels of systolic and diastolic BP 2
Step
Consider home or 24 hour BP monitoring in patients
•Smoking
with stage 1 hypertension without
•Dyslipidaemia:
TOD/complications/risk factors
ototal cholesterol > 5.1 mmol/L, OR 7
oLDL > 3 mmol/L, OR
oHDL men < 1 and women < 1.2 mmol/L
Step
•Diabetes mellitus
•Men > 55 years
3 Lifestyle changes Routine Management
•Women > 65 years •Weight reduction Step 1:Choose any of the
•Family history of early onset of CVD: •Restrict salt, dietary sugars, and saturated
•Men aged <55 years fat
following:*
•Women aged <65 years •Limit alcohol consumption •Hydrochlorothiazide 12.5 -25 mg daily or
•Waist circumference- abdominal obesity: •Increase fruit and vegetables indapamide 1.25 – 2.5 mg daily
•Men ≥ 94 cm •Increase physical activity •CCB
•Women ≥ 80 cm •Stop all tobacco products •ACE-I or ARB
Step •If 20/10mmHg above goal proceed
Target Organ Damage 4
directly to step 2
Step 2
•LVH: based on ECG 1. Combine any 2 of the above
3 2. Combine all 3 of above
oSokolow-Lyons > 35 mv (S in V1 + R in
V5 or V6) 3. Maximize doses of individual agents
oCornell product > 2440 mm.ms (S in V3 Step 3
+ R in aVL + 6 in females) x QRS •Spironolactone 25mg daily (monitor K+
duration) and avoid if eGFR < 45 mls/min)
oR in aVL > 11 mv •β blocker, blocker, minoxidil, centrally
•LVH on echocardiography acting drug, or hydralazine
•Micro-albuminuria: albumin creatine ratio •Consider furosemide 40mg b.d. in place
- 3-30 mg/mmol of thiazide if eGFR < 45mls/min
•Check adherence, secondary causes,
Complications home or 24 hour BP monitoring for white
coat or pseudoresistance, consider
•Coronary heart disease referral to specialist
•Heart failure
•Chronic kidney disease: * CCBs/diuretics preferred in
oalbuminuria > 30mg/mmol OR eGFR < Blacks/Elderly
60ml/min * 24 hour acting drugs and single pill
Is there a hypertensive
Step
•Stroke or TIA combinations preferred
•Peripheral arterial disease
•Advanced retinopathy: urgency or emergency?
5
ohaemorrhages OR BP > 180/110 mmHg
3 No
oexudates
opapilloedema
with symptoms and/or
accelerated TOD
No
Step Are there compelling
Abbreviations Yes
• LVH = left ventricular hypertrophy
6 indications/contraindications?
• eGFR = estimated glomerular filtration rate (see below)
• TOD = target organ damage Refer for
• TIA = transient ischaemic attack
• ACE-I = angiotensin converting enzyme inhibitor hospital
• ARB = angiotensin receptor blocker admission
• CCB = calcium channel blocker
• HF = heart failure
• ISH = isolated systolic hypertension