Management of Hypertension MOHW August 2020

*Adapted from 2020 International Society of Hypertension Global Hypertension Practice Guidelines And
ACC/AHA 2017 guidelines

Resistant Hypertension

Resistant hypertension is defined as seated office BP >140/90 mmHg in a patient treated with
three or more antihypertensive medications at optimal (or maximally tolerated) doses including
a diuretic and after excluding pseudoresistance which is approximately 50% of patients (poor
BP measurement technique, white coat effect, nonadherence and suboptimal choices in
antihypertensive therapy) as well as the substance/drug-induced hypertension and secondary
hypertension.

Resistant hypertension affects around 10% of hypertensive individuals, has a negative impact
on well-being and increases the risk of coronary artery disease, chronic HF, stroke, end-stage
renal disease, and all-cause mortality.

Secondary Hypertension

Consider screening for secondary hypertension in

(1) patients with early onset hypertension (<30 years of age) in particular in the absence of
hypertension risk factors (obesity, metabolic syndrome, familial history etc.)
(2) those with resistant hypertension,
(3) individuals with sudden deterioration in BP control,
(4) hypertensive urgency and emergency,
(5) those presenting with high probability of secondary hypertension based on strong clinical
clues.
Management of hypertension – Non pharmacological

Management of hypertension – Pharmacological

ARBs : Losartan
ACEi : Enalapril
Calcium channel blockers : Amlodipine
Thiazide diuretics : Hydrochlorothiazide
Beta-Blockers : Atenolol and Metoprolol
Alpha and Beta- blocker : Carvedilol
Alpha blocker : Prazosin
Aldosterone antagonist : Spirinolactone
Central sympatholytics : Alpha-methyldopa
Vasodilator : Hydralazine
A practical Algorithm for Management of Hypertension