Mount Carmel Health Partners Clinical Guidelines Hypertension

Hypertension Clinical Guideline
Defini on: Hypertension (HTN) or high blood pressure (HBP) is a chronic medical condi on in which the systemic arterial blood pressure is elevated. HTN is classified as
either primary (essen al) or secondary. About 90–95% of cases are termed “primary HTN,” which refers to high blood pressure for which no medical cause can be found.
The remaining 5–10% of cases (secondary HTN) are caused by other condi ons that affect the kidneys, arteries, heart, or endocrine system.
Risk Factors: HTN is the result of a number of factors: diabetes mellitus, chronic kidney disease (CKD), advancing age, family history, a sedentary lifestyle, stress, obesity
(over 85% of cases occur in those with a BMI greater than 25), sodium sensi vity, tobacco use, alcohol intake, potassium deficiency (hypokalemia), and vitamin D deficiency
all increase the risk of developing HTN. Timely achievement of blood pressure targets within 6 weeks is an important factor of minimizing the risk of adverse
cardiovascular outcomes.
Adult (age ≥18 years)
No
Re-measure BP under ideal
outpa ent condi ons and two
subsequent visits, each scheduled a
week apart.
Reinforce lifestyle modifica ons:
healthy diet, exercise, and smoking
cessa on.
Does BP remain
elevated on
subsequent visits?
Yes
Consider secondary
causes of hypertension.
(see Page 2)
No
Obtain tests: blood glucose, lipid
panel, hematocrit, serum
potassium, crea nine, calcium,
urinalysis, and ECG.
Are test results
within
normal limits?
Assess for cardiovascular
risk factors
(see Page 3).
Yes
Set blood pressure goal and ini ate blood pressure-lowering
medica on based on age, diabetes, and CKD.
Age ≥60 years and no
diabetes and no CKD Age <60 years and no
diabetes and no CKD All ages with
diabetes and no CKD All ages with CKD
Goal SBP <150mm Hg
Goal DBP <90mm Hg Goal SBP <140mm Hg
Goal DBP <90mm Hg Goal SBP <140mm Hg
Goal DBP <90mm Hg Goal SBP <140mm Hg
Goal DBP <90mm Hg
Nonblack
Black
Quick Guide to
Hypertension Care
A desirable treatment
goal is SBP less than
140 and DBP less than
90.
Blood pressure should
be monitored every 3
to 6 months for those
pa ents mee ng
treatment goals.
Blood pressure should
be monitored monthly
if the pa ent is not
mee ng treatment
goals.
Lifestyle modifica on
should be encouraged:
regular exercise, diet,
and smoking cessa on.
Ini ate thiazide-type diure c or
calcium channel blocker (CCB)
alone or in combina on
All Races
Ini ate thiazide-type diure c or
ACEI or ARB or CCB alone or in
combina on
Ini ate ACEI or ARB alone or in
combina on with other class
Select a treatment tra on strategy: A) maximize first medica on before adding second; B) add second medica on
before reaching maximum dose of first; or C) start with 2 medica on classes separately or as a fixed dose combina on.
At goal pressure?
Yes
Con nue current treatment, monitoring and
adjust medica on as appropriate
No
• Reinforce medica on and lifestyle adherence.
• For strategies A and B, add and trate thiazide-type diure c or ACEI or ARB or CCB (use medica on class not previously
selected, and avoid combined use of ACEI and ARB).
• For strategy C, trate doses of ini al medica ons to maximum.
• Consider referral to Mount Carmel Hypertension Center and/or appropriate specialist.
No
At goal pressure?
Yes
Con nue current treatment, monitoring and
adjust medica on as appropriate
November 2018