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Case Definition

Clinical assessment
• May have headacheA,B, dizziness, blurred vision, nauseaA
• Assess family and social history, cardiac risk factors.
• Repeat BP in 10 minutesB
• Height, BMID, physical exam to assess for end organ damage

 

Red Flags

Severe (BP >180/110 D,E)
• Refer to hospital if symptomatic (confusion, headache, chest pain, dyspnea)C,G,H

Management

Moderate (BP 160-180/90-110 D,E)
• Start combination treatment immediatelyA,B,C,H

Mild (BP >140/90 C,D, E)
• Recheck in 1-4 weeksB,C,G with local provider A,B,D,E

General recommendations (target <140/90 D,H, or >130-135/80-85 in diabeticsB,H)
• Provide at least 1-2 month medication supplyC,H
• May add a second agent after 6 month trialD
• Lifestyle modifications C,F,G including low salt dietC,E,F,G, educationC, alcohol and tobacco avoidanceG, exerciseF,G, weight lossF, fruits and vegetablesG

Pharmacologic treatment (specific situations may alter treatment choicesC,G,H,J)
• 1st line: Diuretics(HCTZB,E,F,G,J,K) or ACEI (Enalapril/LisinoprilB,D,E,F,I)
• 2nd line: Beta-blocker or CCBA,D,F,J