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
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