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Strategy Description
Age ≥ 60years Age < 60 years All Ages Diabetes All Ages and Races A Start one drug, titrate tomaximum
present No CKD CKDpresent with or dose, and then add a seconddrug.
without diabetes
BPGoal BPGoal B Start one drug, then add a second
< 150/90 < 140/90 drug before achieving max dose of
BPGoal BPGoal first
< 140/90 < 140/90
C Begin 2 drugs at same time, as
separate pills or combination pill.
Initiate ACEI or ARB, Initial combination therapy is
Nonblack Black
alone or combo recommended if BPis greater than
w/another class 20/10mm Hg abovegoal
Initiate thiazide, ACEI, ARB, Initiate thiazide or CCB,
or CCB,alone or incombo alone or combo
Lifestyle changes:
Yes • Smoking Cessation
At blood pressure goal?
• Control bloodglucose and lipids
No
• Diet
Reinforce lifestyle and adherence Eat healthy (i.e., DASHdiet)
Titrate medications to maximum doses or consider adding another medication (ACEI, ARB, CCB, Thiazide) Moderate alcoholconsumption
Reduce sodium intake to no
Yes more than 2,400mg/day
At blood pressure goal?
• Physical activity
No
Moderate-to-vigorous activity
Reinforce lifestyle and adherence 3-4 days a week averaging 40
Add a medication classnot already selected (i.e. beta blocker, aldosterone antagonist, others) and titrate min per session.
above medications to max (see back of card)
Yes
At blood pressure goal? Continue tx and monitoring
No
Reference: James PA, Ortiz E, et al. 2014 evidence-based guideline for the management
Reinforce lifestyle and adherence of high blood pressure in adults: (JNC8). JAMA. 2014 Feb5;311(5):507-20
Titrate meds to maximum doses, add another med and/or refer to hypertension specialist
Card developed by Cole Glenn, Pharm.D. & James LTaylor, Pharm.D.
CompellingIndications
Hypertension Treatment
Indication Treatment Choice
Heart Failure ACEI/ARB + BB+ diuretic +spironolactone
Post –MI/Clinical CAD ACEI/ARB AND BB
Beta-1 Selective Beta-blockers – possibly safer in patients
CAD ACEI, BB, diuretic, CCB with COPD, asthma, diabetes, and peripheral vascular
Diabetes ACEI/ARB, CCB, diuretic disease:
• metoprolol
CKD ACEI/ARB
• bisoprolol
Recurrent stroke prevention ACEI, diuretic • betaxolol
Pregnancy labetolol (firstline), nifedipine, methyldopa • acebutolol
terazosin 1-5mg, doxazosin 1-4mg given atbedtime Alpha-blockers may cause orthostatic hypotension
Centrally- clonidine 0.1-0.2mg twice daily, methyldopa 250-500mg twice daily Clonidine available in weekly patch formulation for
acting Agents resistant hypertension
guanfacine 1-3mg