Treatment Algorithm Essential Hypertension

Obtain History & Physical

Confirm Diagnosis: BP readings > 140/90 on 2 occasions in 6 weeks OR a single BP reading with systolic BP >200 or diastolic BP > 120

Rule out white coat hypertension Rule out other causes: Hyperthyroid, Renal disease, Hyperaldosteronism, Pheochromocytoma, OCPs, Drug use

Educate Patient about medical condition, complications, self-care BP Goal <130/85 Diabetic Goal 130/80

High Normal or Stage 1 Hypertension

Stage 2 & 3 Hypertension, Diabetics or CAD History Initial Management CBC, Chem-7, urinalysis, lipid profile, baseline EKG, fasting plasma glucose

Diet Modification (trial of 3-6 months) reduce salt, fatty foods avoid caffeine promote potassium rich foods

1. 2.

Medications antihypertensive drugs Lipid-lowering drugs, if indicated. Ongoing Management

1. 2. Lifestyle Modification (trial 3-6 months) exercise & weight loss, stress reduction, stop tobacco, alcohol, drug use

Initial Antihypertensives uncomplicated patient: diuretic, beta blocker diabetics or CHF patients: ACE inhibitor

1. 2. 3.

follow-up appointments every 1-3 months annual CBC, Chem-7, urinalysis, lipid profile annual ophthalmologists exam

1. 2.

BP unresponsive or uncontrolled increase med to appropriate maximum dose substitute or add another agent from a different class such as Ca+ channel blockers, alpha blockers, ARBs, etc.