Index - 28 - 29 - 30/31 - 32/33/34 - 35 - 36/37/38/39 - 40/41 - 42/43 - 44/45/46 - 47/48 - 49 - 50/51/52/53
54/55 - 56 - 57/58 - 59 - 60/61 - 62 - Pages online: A - B - C - D - E - F - G - References
HYPERTENSION: DIAGNOSIS AND MANAGEMENT
BLOOD PRESSURE (mmHG) i- LEVELS + DIAGNOSIS & GRADING OF HYPERTENSION
Other risk factors
and disease history		 Normal:
SBP 120-129
or DBP 80-84		 High normal:
SBP 130-139
or DBP 85-89		 Grade 1:
SBP140-159
or DBP 90-99		 Grade 2:
SBP 160-179
or DBP100-109		 Grade 3:
SBP > 180
or DBP > 110
No other risk factors Average risk Average risk Low added risk Moderate added risk High added risk
No BP intervention No BP intervention Lifestyle changes for several months ii, then possible drug therapy iii Lifestyle changes for several months ii, then drug therapy iii Immediate drug therapy iii and lifestyle changes ii
1-2 risk factors iv Low added risk Low added risk Moderate added risk Moderate added risk Very high added risk
Lifestyle changes ii Lifestyle changes ii Lifestyle changes for several months ii, then drug therapy iii Lifestyle changes for several months ii, then drug therapy iii Immediate drug therapy iii and lifestyle changes ii
3 or more risk factors iv or target organ disease v or diabetes Moderate added risk High added risk High added risk High added risk Very high added risk
Lifestyle changes ii Drug therapy iii and lifestyle changes ii Drug therapy iii and lifestyle changes ii Drug therapy iii and lifestyle changes ii Immediate drug therapy iii and lifestyle changes ii
Associated clinical conditions vi High added risk Very high added risk Very high added risk Very high added risk Very high added risk
Drug therapy iii and lifestyle changes ii Immediate drug therapy iii and lifestyle changes ii Immediate drug therapy iii and lifestyle changes ii Immediate drug therapy iii and lifestyle changes ii Immediate drug therapy iii and lifestyle changes ii
i SBP =systolic blood pressure; DBP = diastolic blood pressure. Repeated blood pressure measurements should be used for stratification
ii Recommended life style interventions - see p. 40. Table adapted from J. Hypertension 2003; 21:1779-86.
iii See next page
iv Risk factors include age (>45 years for men; > 55 years for women), smoking, family history of premature CVD
v Target organ disease: left ventricular hypertrophy, ultrasound evidence of arterial wall thickening, microalbuminuria.
vi Associated clinical conditions: CVD, IHD, renal disease, peripheral vascular disease, advanced retinopathy.
Warning: Caution regarding drug-drug interactions with antihypertensive drugs and ART.
 
CHOOSING DRUGS i FOR PATIENTS NEWLY DIAGNOSED WITH HYPERTENSION

Abbreviations + details:

  • A = ACE inhibitor (e.g. perindopril, lisinopril, ramipril) (consider anglotensin-II receptor antagonist (e.g. losartan, candesartan)
    if ACE intolerant)
  • C = Dihydropyridine calcium-channel blocker (e.g. amlodipine).
    If not tolerated, verapamil (note: dose with caution with PIs which may increase plasma concentrations leading to toxic reactions),
    or diltiazem may be used.
  • D = thiazide-type diuretic
i Several anti-hypertensive drugs interact with the pharmacokinetics of ART – check always for drug-drug interactions
ii Black patients are those of African or Caribbean descent, and not mixed-race, Asian or Chinese patients
iii Await 2-6 weeks to assess whether target (p. 42) is achieved – if not go to next step.
iv Requirement of 4-5 drugs to manage hypertension requires specialist training