ABSTRACT
Learning objectives Know examples of all the main classes of drugs used for hypertension with ■ some precautions and contraindications in each group. Be able to give a brief account of lifestyle and dietary recommendations. ■
Changes in lifestyle: ■ diet ❚ exercise. ❚
Drugs: ■ ACE inhibitors ❚ angiotensin-II receptor blockers (ARBs) ❚ β ❚ -blockers α ❚ -blockers calcium channel blockers ❚ diuretics ❚ direct vasodilators ❚ direct renin inhibitor (Aliskerin). ❚ †
Treatment thresholds: ■ blood pressure: systolic 140-159 mmHg or diastolic 90-99 mmHg: + ❚ no organ damage + no cardiovascular complications:
treatment: lifestyle and dietary counselling; no drugs; monthly ♦ check-ups
blood pressure: systolic 140-159 mmHg or diastolic 90-99 mmHg + ❚ evidence of organ damage or cardiovascular complications or diabetes:
treatment: lifestyle and dietary counselling + drug therapy if patient’s ♦ condition and raised BP values are sustained for 12 weeks
blood pressure: systolic 160-179 mmHg or diastolic 100-109 mmHg ❚ + no organ damage + no cardiovascular complications:
treatment: lifestyle and dietary counselling; monitor weekly + drug ♦ therapy if patient’s condition and raised BP values are sustained over 4-12 weeks
blood pressure: systolic 160-179 mmHg or diastolic 100-109 mmHg ❚ + cardiovascular complications + organ damage or diabetes with symptoms persisting over 3-4 weeks:
treatment: lifestyle and dietary counselling; monitor + drug therapy ♦ if patient’s condition and raised BP values are sustained over 3-4 weeks
blood pressure: systolic 180-219 mmHg or diastolic 110-119 mmHg: ❚ treatment: lifestyle and dietary counselling; monitor + drug therapy ♦ if patient’s condition and raised BP values are sustained over 1-2 weeks
blood pressure: systolic ❚ ≥ 220 mmHg or diastolic ≥129 mmHg: treatment: lifestyle and dietary counselling + treat immediately with ♦ drugs.
