How can I outline a management plan for the patient with essential hypertension?

A management plan for the initial assessment, investigation and follow up of a patient presenting with elevated blood pressure is presented below.

INITIAL ASSESSMENT

• Measure BP*
• History (including drug and family history) and examination
• Baseline screen for secondary causes of hypertension**:
  urinalysis, creatinine and electrolytes
• Assessment of end-organ damage***:
  ECG, fundoscopy
• Assessment of other cardiovascular risk factors:
  age, gender, BP, total and HDL-cholesterol
  ECG-LVH, diabetes, smoking status

INSTITUTE LIFESTYLE MODIFICATIONS

• Salt (sodium restriction from 10g/d to 5g/d expect 5/3 mmHg reduction in BP)
• Alcohol (change depends on amount consumed)
• Weight (expect 1-2 mmHg BP reduction for every kg lost)
• Aerobic exercise (4/3 mmHg reduction for thrice weekly aerobic exercise)
• Smoking cessation (consider nicotine replacement)

COMPUTE CARDIOVASCULAR RISK
Use BP level and estimates of absolute and relative cardiovascular disease risk to guide:

• Anti-hypertensive drug therapy
  initial treatment with thiazide diuretic or beta blocker unless contraindicated or not tolerated
• Cholesterol lowering with statinsconsider aspirin

REVIEW

• Adequacy of treatment: BP and cholesterol target
• Side effects from treatment
• Lifestyle modifications