GIM Question 7 Instructor

What are the indications to treat hypertension?The indications to treat hypertension are:

  • Hypertension emergency
    • Asymptomatic diastolic BP ≥ 130
    • Average documented SBP >140 and/or DBP >100 with clinical/laboratory evidence of end-organ damage
  • Average documented SBP >160 and/or DBP > 100 with or without end-organ damage

What is the first line therapy for novel uncomplicated hypertension?
First line therapy for novel uncomplicated hypertension is a thiazide diuretic.

Beta blockers should be used in patients <60 years old.

ACE inhibitors, ARBs, or long-acting CCBs can be used as alternative first-line therapies if contraindications to the above exist (ACEi are relatively contraindicated in black patients).

The following are first-line therapies for hypertension in unique settings:

  • ACS
    • Hypertension with stable angina – Beta blocker or CCB
    • Hypertension post-STEMI/NSTEMI – ACEi + Beta blocker, or ACEi
  • CHF
    • ACEi + Beta blocker
    • Thiazide diuretic or loop diuretic for volume management
  • Diabetes
    • With cardiovascular and/or renal disease – ACEi + Beta blocker
    • Without the above – ACEi

Patients admitted to hospital for other conditions (i.e. pneumonia, rheumatologic problems) may have isolated hypertension. In these cases, acute stress (i.e. pain, anxiety) can cause an isolated hypertension. To manage hypertension in these patients:

  • Treat the underlying condition and any discomfort
  • Monitor their blood pressure
  • Follow-up with patient in clinic for BP monitoring after discharge
  • Initiate anti-hypertensive treatment in hospital if evidence of a hypertensive crisis

Hypertension Canada. Canadian Hypertension Education Program (CHEP) Recommendations. Retrieved from

Subscribe to Pearls

Uncle Sam wants you to subscribe to Medical Pearls

Subscribe today! It’s always free, and you can easily unsubscribe at any time. We will never share your email address. Subscribe to...

Multiple Pearls
Cardiology Pearls
Endocrinology Pearls
Hematology Pearls
Nephrology Pearls
Rheumatology Pearls
Transplant Pearls
General Internal Medicine Pearls
Instructor Pearls

Subscribe to receive your pearls today—it's free!