B-QuiCK: Hypertension

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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.
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