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
Resource
Hypertension Canada. Canadian Hypertension Education Program (CHEP) Recommendations. Retrieved from https://www.hypertension.ca/en/chep/
