HYPERTENSION-MANAGEMENT

SUMMARY

1. In the general population: including those with diabetes, treat initially with a thiazide-type diuretic, ACEI, or ARB, CCB (tip: TAAC)

2. In heart failure: initially treat hypertension with a thiazide-type diuretic & ACEI, which is more effective than a CCB in improving heart failure outcomes.

3. In CKD (regardless of race or diabetes, population > 18 years): treat with ACEI or ARB.

4. Use any drug or drug combination with the fewest side effects to get the BP < 140/90mmHg (or 150/90 for population > 60 years).

5. As monotherapy, beta-blockers are not recommended as the first line agents because they are associated with an increased risk of stroke and heart disease.

6. Patients who are not controlled with monotherapy usually have a better response with the addition of a low-dose 2^nd drug, rather than an increase in dose of the first drug.

7. Initially treat patients with BP > 160/100mmHg with 2 drugs.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].