Hypertension: investigations, treatment initiation and non-pharmacological treatment
EBM Guidelines
Apr 1, 2021 • Latest change Mar 7, 2024
Table of contents
- Essentials
- General remarks evd
- Blood pressure measurement evd
- Classification of BP levels
- Initial investigations in primary care
- Indications for consulting specialized care
- Non-pharmacological treatment of risk factors for hypertension evd
- Initiation of drug treatment according to the severity of hypertension
- Treatment goal evd
- Follow-up evd
- References
Extract
- The diagnosis of hypertension is based on levels measured in the surgery (preferably by a nurse) and, additionally, at home or by ambulatory monitoring.
- Identify risk factors and concomitant diseases and, in primary prevention in ‘healthy’ people, calculate overall risk using a risk calculator appropriate for the local population.
- The aim is to reduce cardiovascular disease risk through effective lifestyle guidance and medication (statins, in particular), as necessary.
- Exclude secondary hypertension.
- Drug treatment is recommended if, despite lifestyle interventions, the systolic BP level is ≥ 140 mmHg or the diastolic BP level is ≥ 90 mmHg as measured in the surgery, and the BP level measured at home or the daytime level during ambulatory blood pressure monitoring is ≥ 135/85 mmHg.
- The goal of treatment is to reduce systolic BP to below 140 mmHg and diastolic pressure to below 90 mmHg (home measurements < 135/85 mmHg). For persons over 80 years of age the goal is < 150/90 mmHg (home measurements < 140/85 mmHg). The target is lower if there is a high risk of disease or the patient has diabetes or a renal disease and the target can be achieved without harmful effects.
Linked evidence summaries
- NSAIDs may elevate blood pressure and antagonise blood pressure lowering effect of antihypertensive medication, but the effects may differ between agents.C
- Cyclosporine increases blood pressure compared to placebo in a dose-related fashion.A
- Reduction in salt intake lowers blood pressure . Long term effects on mortality and cardiovascular morbidity remain unclear.A
- Advice to increase fruit and vegetables as a single intervention may have favourable effects on systolic blood pressure and might possibly have favourable effect on other cardiovascular risk factors.C
- An increase in calcium intake slightly reduces blood pressure.A
- Treatment with a weight loss diet appears to reduce weight and blood pressure in patients with essential hypertension.B
- Reducing excessive alcohol intake is effective for reducing blood pressure.A
- Walking appears to reduce systolic blood pressure in all ages and both sexes, and may reduce diastolic blood pressure and heart rate.B↑↑
Search terms
Blood Pressure, Blood Pressure Determination, Blood Pressure Monitoring, Ambulatory, Blood Pressure Monitoring, Ambulatory, Cardiology, Hypertension, I10, I15*, Internal medicine, Korotkoff sounds, R03.0, Sphygmomanometers, blood pressure cuff, digital blood pressure monitor