Hypertension : B-QuiCK

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Hypertension management: B-QuiCK

Is antihypertensive treatment required?

Patients with a blood pressure of ≥ 160/100 mmHg should be initiated on antihypertensive treatment immediately, in addition to lifestyle changes, regardless of their five-year CVD risk.

For all other patients with a blood pressure persistently ≥ 130/80 mmHg, the 2018 Ministry of Health cardiovascular risk consensus statement recommends calculating their five-year CVD risk to guide antihypertensive medicine decisions. In patients with:

Five-year CVD risk < 5%: antihypertensive treatment is not recommended; proceed with lifestyle changes
Five-year CVD risk 5 – 15%: consider antihypertensive treatment if blood pressure is ≥ 140/90 mmHg, in addition to lifestyle changes
Five-year CVD risk ≥ 15%: antihypertensive treatment is recommended, in addition to lifestyle changes

Summary: approach to antihypertensive treatment of patients with uncomplicated hypertension in primary care. N.B. Co-morbidities can influence the selection of approach to antihypertensive use. See the full article for more information.

^* Blood pressure should be monitored at least every four-to-six weeks during medicine titration until blood pressure targets have been achieved. The frequency of follow-up in the long-term depends on a range of patient-specific factors, e.g. the severity of hypertension in the context of the patient’s overall CVD risk.

^†Such as a beta-blocker or an alpha-blocker

Targets for the treatment of hypertension

	Clinic measurement	24-hour ambulatory or at-home measurement
“High” CVD risk including current atherosclerotic CVD, heart failure, reduced ejection fraction, diabetes, CKD, aged ≥ 65 years, five-year CVD risk of ≥ 15%	< 130/80 mmHg	< 125/80 mmHg
“Lower” CVD risk None of the above risk factors	< 140/90 mmHg	< 135/90 mmHg
Frailty, dementia, limited life expectancy	Discuss treatment goals to guide decision making; targets can be more lenient and antihypertensive doses may need to be reduced or stopped entirely depending on patient-specific factors.

Clinic measurement

24-hour ambulatory or at-home measurement

“High” CVD risk

including current atherosclerotic CVD, heart failure, reduced ejection fraction, diabetes, CKD, aged ≥ 65 years, five-year CVD risk of ≥ 15%

< 130/80 mmHg

< 125/80 mmHg

“Lower” CVD risk

None of the above risk factors

< 140/90 mmHg

< 135/90 mmHg

Frailty, dementia, limited life expectancy

Discuss treatment goals to guide decision making; targets can be more lenient and antihypertensive doses may need to be reduced or stopped entirely depending on patient-specific factors.

It is strongly recommended to review the original resource at your convenience for full details of recommendations and evidence.

See full article here: Hypertension in adults: the silent killer

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B-QuiCK: Hypertension

Hypertension management: B-QuiCK

Is antihypertensive treatment required?

Summary: approach to antihypertensive treatment of patients with uncomplicated hypertension in primary care. N.B. Co-morbidities can influence the selection of approach to antihypertensive use. See the full article for more information.

Targets for the treatment of hypertension

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