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Management of Hypertension
February 2004
This poc"et card is adapted from The Seventh #eport of the $oint %ationa! &ommittee on Prevention' (etection' va!uation' and Treatment of High )!ood Pressure *$%& +,.mportant .nformation #egarding $%& + Guide!ines/ Goa! b!ood pressure *)P, is 0140230 mm Hg or 0140250 mm Hg for patients 6ith diabetes or chronic "idney disease For patients over age 70' systo!ic b!ood pressure *S)P, is more important than diasto!ic b!ood pressure *()P, as a ris" factor for the deve!opment of coronary heart disease *&H(, Starting at 1172+7 mm Hg' &H( ris" doub!es 6ith each increment of 20210 mm Hg throughout the b!ood pressure range Patients 6ho are normotensive at age 77 have a 308 !ifetime ris" for deve!oping hypertension *HT%, Hea!th9promoting !ifesty!e modifications *See Tab!e 4, to prevent &H( shou!d be considered for those patients 6ho are considered prehypertensive *See Tab!e 1, Thiazide-type diuretics should be initial drug therapy for most patients, either a!one or combined 6ith other drug c!asses un!ess the patient has a compe!!ing indication for use of drug therapy from another drug c!ass Many patients 6i!! re:uire t6o or more drugs to achieve the goa! )P ;o6 doses of t6o drugs may be more effective and better to!erated than a high dose of one drug Patients 6ith mean )P< 147257 measured at home are genera!!y considered to be hypertensive-
Table 1
Table &
%ot at Goa! )P *0140230 mm Hg or 0140250 mm Hg for those 6ith diabetes or chronic "idney disease, .nitia! (rug &hoices *See Tab!es 5 B 3,
Stage 1 Hypertension/ S)P 140 to 173 mm Hg or ()P 30 to 33 mm Hg Thiazide diuretics are first choice
Stage Hypertension/ S)P <1=0 mm Hg or ()P <100 mm Hg Drug Combination 0Thiazide 1 #C(- or Beta Bloc2er3
%ot at Goa! )P
Table 4
Classification and 'anagement of Blood Pressure for #dults #ged 15 6ears or 7lder
%is2 8roup %orma! Prehypertension Stage 1 HT% Stage 2 HT% SBP mm Hg 0 120 120 to 143 140 to 173 < 1=0 DBP mm Hg 0 50 50 to 53 30 to 33 < 100 !ifestyle 'odification 0Table &3 ncourage Ees Ees Ees Drug Therapy %o &onsider for patients 6ith compe!!ing indications *See Tab!e 5, Ees Ees
Table 9
G(ietary ?pproaches to Stop Hypertension GG1 drin" H I oD or 17 m; ethano! *e-g-' 12 oD beer' 7 oD 6ine' 1-7 oD 509proof 6his"ey,-
)ase!ine FJ' S&r- Fo!!o69up soon after initiation' after dose changes' or changes in patient status- &hec" periodica!!y *e-g-' annua!!y, if patient status is stab!e%o routine drug9re!ated !aboratory monitoring recommended-
Al#ha-Blockers )enign Prostatic Hyperp!asia *)PH,Caution/ not to be used as first9!ine or monotherapy (oAaDosin 1 to 1= mg dai!y for HT% due to possib!e increased ris" of HFTeraDosin 1 to 10 mg dai!y to ).( &iscellaneous &ontact pharmacy for information on these therapies and methy!dopa' minoAidi!' B guanfacine&!onidine tab!et 0-1 to 0-5 mg ).( to T.( &!onidine patch 0-1 to 0-4 mg2dayN 6ee"!y Hydra!aDine 27 to 100 mg ).( to L.( G%ot an inc!usive !ist' refer to prescribing information for a more comp!ete !ist
)ase!ine FJ' S&r- Fo!!o69up soon after initiation' after dose changes' or changes in patient status- &hec" periodica!!y *e-g-' annua!!y, if patient is stab!e%o routine drug9re!ated !aboratory monitoring recommended%o routine drug9re!ated !aboratory monitoring recommended-