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Essential hypertension
Jimbo M, Dorsch MP, Ealovega MW, Van Harrison R, Jamerson KA [University of Michigan Health System]
2014
practice guideline

KEY ASPECTS AND RECOMMENDATIONS: DIAGNOSIS: Although a single, carefully taken blood pressure (BP) reading may predict future cardiovascular risk, for clinical purposes this risk is better identified by taking the mean BP level from recordings over several visits. Home and ambulatory blood pressure monitoring helps improve BP control, and identifies "white coat" and "masked" hypertension (IIA). If home BP monitoring is used, careful calibration of the BP monitor and thorough patient education are essential. Individuals with mean BP > 135/80 should be screened for diabetes (IB). TREATMENT: For patients without diabetes or end organ damage, target of BP for Age < 60 years is < 140/90 mmHg (IA). Age => 60 years is < 150/90 mmHg (IB). For patients with diabetes or end organ damage (eg, renal insufficiency, retinopathy, CHF, CAD, PVOD, cerebrovascular disease), appropriate treatment of hypertension (HTN) provides significant improvements in clinical outcomes (IA). Systolic goals have not been specifically defined. A target systolic blood pressure of < 140 mmHg (ID) and diastolic BP goal of < 90 mmHg (IB) is recommended. Treatment of SBP over 160 mmHg is important in reducing CVA and CHF risk (IA). Lifestyle modifications to lower BP are important adjuncts to drug therapy (IA). Begin therapy with a thiazide diuretic, ACE inhibitor, or long-acting dihydropyridine calcium channel blocker for almost all patients. Add second and third agents as needed to achieve effective BP reduction goals (IA). Specific illnesses may guide the initial and subsequent choice of agents, eg, ACE inhibitors (ARB for those unable to tolerate ACE inhibitors) for patients with renal disease, diabetes with either micro- or macroalbuminuria, or LV dysfunction. Beta-blockers for those with CAD or CHF. Over 70% of individuals require two or more drugs to achieve BP goals. A fixed combination therapy may be cost-effective. Once a day medications increase compliance and are preferred.

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