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Structured Approach to Hypertension Management: Stepwise Treatment and Medication Considerations

Cardiovascular system

Step 1: Initial Assessment and Treatment Selection

  1. Assessment:

    • Gather patient information, including medical history, age, ethnicity, comorbidities (such as diabetes), and current medications.
    • Measure blood pressure accurately using recommended techniques and devices.

  2. Treatment Selection:

    • Identify the patient's profile based on age, ethnicity, and comorbidities according to guideline recommendations.
    • Choose initial medications:
      • ACE Inhibitors or ARBs for individuals with type 2 diabetes or aged under 55 but not of Black African or African–Caribbean origin.
      • Calcium-Channel Blockers (CCBs) for individuals aged 55 or over without type 2 diabetes or of Black African or African–Caribbean origin.
      • Consider alternatives like Thiazide-like Diuretics if initial medications are not tolerated.

Step 2: Treatment Adjustment for Uncontrolled Hypertension

  1. Review and Adjustment:
    • Assess the effectiveness of Step 1 treatment after an appropriate period.
    • If hypertension remains uncontrolled, consider:
      • Adding a CCB or Thiazide-like Diuretic to the current medication regimen.
      • Evaluate patient response and potential side effects.

Step 3: Optimization and Combination Therapy

  1. Optimization:
    • Review medication adherence and assess for any lifestyle modifications.
    • Adjust medication doses to achieve target blood pressure levels.
    • Consider combining medications from different classes if needed, based on patient response and tolerability.

Step 4: Addressing Resistant Hypertension

  1. Identification of Resistant Hypertension:

    • Confirm elevated blood pressure through alternative measurements (ambulatory or home recordings).
    • Assess for potential causes of resistant hypertension, including adherence, lifestyle factors, and secondary causes.

  2. Further Intervention:

    • Monitor for postural hypotension and discuss adherence with the patient.
    • Consider additional medications such as Spironolactone or seek specialist advice for resistant cases.
    • Evaluate for contraindications and side effects of added medications.

Key Considerations Throughout:

  • Patient Education: Provide information on medications, lifestyle modifications, and the importance of adherence.
  • Regular Monitoring: Schedule follow-up visits to monitor blood pressure, assess side effects, and evaluate treatment response.
  • Individualized Approach: Tailor treatment plans based on patient characteristics, responses, and tolerances.
  • Collaborative Care: Engage patients in shared decision-making and consider multidisciplinary approaches for complex cases.

Key Points to Watch Out For:

  • Adherence: Ensure patients take medications as prescribed.
  • Monitoring: Regularly monitor blood pressure and assess for side effects.
  • Combination Therapies: Tailor combinations based on individual responses.
  • Special Considerations: Check for contraindications, especially in pregnancy or certain ethnic groups.

These guidelines provide a structured approach to treating hypertension, emphasizing individualized care and a stepwise escalation based on treatment response and patient characteristics. Always consult with healthcare providers for specific medication recommendations and adjustments based on individual patient needs and considerations.

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Cardiovascular system

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