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Chapter 2
•
Cardiovascular Care
29
Treatment of Hypertension
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure has developed an innovative flow chart to guide the treatment of patients with hypertension.
Teaching About Hypertension
•
Teach the patient to
use a self-monitoring
blood pressure cuff
and to record the
reading at least twice
weekly in a journal
for review by the physician at every
office appointment.
•
Tell the patient and family to keep
a record of drugs used in the past,
noting especially which ones are or
are not effective.
•
To encourage compliance with
antihypertensive therapy, suggest
establishing a daily routine for
LESSON PLANS
taking medication. Tell patient
to report any adverse reactions to
prescribed drugs. Advise patient
to avoid high-sodium antacids and
over-the-counter cold and sinus
medications containing harmful
vasoconstrictors.
•
Help the patient examine and
modify their lifestyle. Suggest
stress-reduction groups, dietary
changes, and an exercise program,
particularly aerobic walking, to
improve cardiac status and reduce
obesity and serum cholesterol
levels.
•
Encourage a change in dietary
habits. Help obese patients plan
a reducing diet. Advise against
intake of high-sodium foods (such
as pickles, potato chips, canned
soups, and cold cuts), table salt,
and foods high in cholesterol and
saturated fat.
•
Teach the patient and family that
this is a lifelong treatment. Warn
the patient and family about
complications that may occur from
noncompliance and uncontrolled
blood pressure, such as stroke and
heart attack.
•
Optimize dosages or add additional
drugs until goal BP is achieved.
•
Consider consultation with hypertension
specialist.
Not at goal blood pressure (BP) (
<
140/90 mm Hg)
(
<
130/80 mm Hg for patients with diabetes or chronic kidney disease)
Stage 1 Hyper tens ion
(systolic BP 140 to159 mm Hg OR diastolic
90 to 99 mm Hg)
Thiazide-type diuretics for most; consider
angiotensin-converting enzyme (ACE)
inhibitors, angiotensin II receptor blockers
(ARBs), beta-adrenergic blockers, calcium
channel blockers, or combination
•
Drug(s) for compelling
indications (see prescriber)
•
Other antihypertensive
drugs (diuretics, ACE
inhibitors, ARBs, beta-
adrenergic blockers,
calcium channel blockers)
as needed
Not at Goa l BP
Stage 2 Hyper tens i on
(systolic BP
≥
160 mm Hg OR
diastolic BP
≥
100 mm Hg)
Two-drug combination for most
(usually thiazide-type diuretic and
ACE inhibitor, ARB, beta-adrenergic
blocker, or calcium channel
blocker)
Without compelling indications
With compelling indications
In i t i a l Drug Cho i ces
L i fes t y l e Modi f i cat i ons
Source: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. U.S.
Department of Health and Human Services, NIH, NHLBI; 2004.