Seven keys to treating hypertension in primary care
Blood pressure is one of the most important modifiable risk factors for cardiovascular disease. Hypertension significantly raises the risk of stroke, heart failure, coronary heart disease and chronic kidney disease, and is in fact regarded as a cardiovascular disease in its own right.
Managing hypertension has been a subject of considerable controversy over the past few years, with the debate revolving around how aggressively it should be treated, so-called white-coat hypertension, and the importance of home blood pressure monitoring.
Current Australian recommendations were updated in 2016 and include a number of changes from previous guidelines, including a new recommendation for ambulatory or home monitoring in patients with clinic BP of ≥ 140/90 mmHg.
Here are seven key recommendations from the guidelines:
- Patients with suspected hypertension should have their absolute cardiovascular disease risk calculated using the Australian absolute cardiovascular disease risk calculator;
- Recommend an antihypertensive for patients with a low cardiovascular risk (under 10%) and blood pressure that is persistently 160/100mmHg or higher;
- Recommend an antihypertensive for patients with a medium cardiovascular risk (10-15%) and blood pressure that is persistently 140/90mmHg or higher.
- Recommend an antihypertensive for patients with normal blood pressure but high cardiovascular disease risk (greater than 15%).
- Use home or ambulatory blood pressure monitoring to confirm blood pressure if the clinic blood pressure is 140/90mmHg or higher.
- ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers and thiazide-like diuretics are the first-line antihypertensives of choice;
- Any of these first-line antihypertensives can be recommended for patients with hypertension and diabetes, chronic kidney disease or a history of stroke.
Source: Guideline for the diagnosis and management of hypertension in adults; MJA, 2016
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