Hypertension is defined as systolic blood pressure greater than 130 or diastolic blood pressure greater than 80 mm of Hg. The goals and classification of hypertension are recently changed, now if the systolic blood pressure is greater than 130 mm of Hg or diastolic blood pressure greater than 85 mm of Hg then the patient is labelled as a case of stage 1 hypertension. If systolic blood pressure is greater than 140 mm of Hg or diastolic blood pressure greater than 90 mm of Hg then the patient is termed as a case of stage 2 hypertension.

Management of Hypertension.  Approach Guidelines.

After the diagnosis of hypertension first-line drug is either an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) or a Calcium Channel Blocker (CCB). ACE inhibitors have a higher incidence of adverse effects, thus Angiotensive receptor blockers are used.

In Blacks, Calcium channel blockers are the first line drugs

In Whites or Asians, ACEi or ARBs are the first line drugs.

If blood pressure is still not controlled, increase the doses of the single drug to maximum if tolerated. If blood pressure is still not controlled, then add a CCB to ARB or ACEi, or in case of a black patient, add an ACEi or ARB to CCB.

If BP is still not controlled, then increase the dose of the 2nd drug to the maximum dose.

If BP is still not controlled then add a 3rd drug which is a low dose Thiazide-like diuretic.

If BP is still not controlled and potassium is less than 4.5 meq/L then add the fourth drug which is spironolactone.

If potassium is greater than 4.5 then increase the dose of thiazide diuretic that you had added previously.

If BP is still not controlled than consider adding a beta blocker, or an alpha-blocker.