Hypertension

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Blood Pressure (BP) targets

  • essential hypertension: BP less than 140/90 mmHg
  • if chronic kidney disease (CKD): BP less than 140/90 mmHg  
  • if chronic kidney disease (CKD) and albuminuria (urine albumin:creatinine ratio greater than 30mg/mmol): BP less than 130/80 mmHg
  • if diabetes: BP less than 140/80 mmHg  
  • if diabetes and eye, cardiovascular or kidney damage including microalbuminuria (2 of 3 morning samples: ACR >2·5mg/mmol for males and >3·5mg/mmol for females) BP less than 130/80 mmHg. Indapamide

Try to avoid systolic blood pressure below 120 mmHg: www.nice.org.uk and www.renal.org.

If BP is not controlled at each step progress to next step.

Advise all patients on lifestyle measures, eg smoking, physical activity, weight, alcohol, diet (including salt intake).

Pathway

 

 

*ACE inhibitor:

  • lisinopril (start at 5mg daily, usual maintenance 20mg) or perindopril erbumine if first dose hypotension an issue (start at 2 to 4mg daily).
  • if intolerant of ACE inhibitor consider angiotensin-II receptor antagonist.
  • issue ‘Sick Day Rule’ card.
  • check U&Es 1 to 2 weeks after starting/dose increase. Monitor annually if stable.
  • avoid the combination of ACE inhibitor and angiotensin-II receptor antagonist.
  • use caution when combining ACE inhibitors or angiotensin-II receptor antagonists with spironolactone due to risk of hyperkalaemia.

Beta-blocker therapy: may be indicated as first-line therapy in ischaemic heart disease. 

Primary prevention: if diabetes or 10 year risk of CVD is 20% or more, or a strong family history of premature vascular disease, recommend lipid-regulating therapies; see guidance and the ASSIGN score at http://assign-score.com.

Antiplatelet drugs (aspirin and clopidogrel): use in secondary prevention only (ensure continued if vascular disease is present).

Editorial Information

Last reviewed: 31 May 2016

Next review: 31 May 2018

Author(s): Cardiovascular Review Group of TP Editorial Board

Approved By: Formulary Subgroup of ADTC

Reviewer Name(s): Peter Clarkson, Duncan Scott, Stewart Lambie