Hypertensive guidelines
Hypertensive patient BP >140/90
General advice measures
Reduce salt intake
Stop smoking
Regular exercise
Lose weight
Avoid excessive alcohol
Step 1:
Diuretic
HCT 25 mg od
Or bendroflumethazide 2.5mg od
Step 2:
Add calcium channel antagonist
Amlodipine5-10mg od
Or Nifedipine 10-20 mg bd
Step 3: (step 1 in diabetics)
Add ACE inhibitor
Enalapril 10-20mg od
Or Captopril 12.5-25 mg bd
Ace inhibitors may damage renal function in renal artery stenosis. If sudden
deterioration in U+E then stop ACE.
Avoid ACE inhibitors in pregnancy and breast feeding.
Step 4:
Add Beta blocker
Atenolol 50-100mg od
Or Propanolol 40-80 mg tid
Step 5:
Specialist consultation, ? methyldopa 500mg od
Provided by T. Whitfield 2012
Emergency Hypertension
Emergency hypertension is defined as hypertension causing blindness, encephalopathy
or convulsions. It usually has a diastolic blood pressure > 120 mg/Hg.
The blood pressure should be brought down gradually aiming for diastolic BP
100mg/Hg or lowered by 20-30mg/Hg in the first 24 hours which ever invlolves
lowering the BP the least.
Too fast lowering of the blood pressure can affect cerebral blood flow.
In emergency severe hypertension use hyralazine 5-10mg IV and recheck 1-2 hours
later repeat dosing as necessary.
Secondary hypertension
The majority of hypertension is classified as essential hypertension of no known cause.
If a younger patient presents with hypertension it may be appropriate to screen for a
secondary cause.
Renal disease: glomerulonephritis, renal vascular disease and polycystic kidneys are all
causes of hypertension.
Endocrine diseases such as cushings disease and conns syndrome can also cause
hypertension. Discuss this with seniors if suspected.
Provided by T. Whitfield 2012