What are the key monitoring parameters for patients starting antihyper

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Key monitoring parameters for patients initiating antihypertensive therapy include:

Regular measurement of blood pressure using clinic measurements, aiming for targets below 140/90 mmHg for adults under 80 years and below 150/90 mmHg for those 80 and over, with clinical judgement for frailty or multimorbidity. Home or ambulatory blood pressure monitoring (HBPM/ABPM) can be used, with targets 5 mmHg lower than clinic measurements (135/85 mmHg for under 80, 145/85 mmHg for 80 and over) ,.
Assessment of renal function by measuring serum creatinine, electrolytes, and estimated glomerular filtration rate (eGFR) .
Testing urine for albumin:creatinine ratio (ACR) to detect proteinuria .
Measurement of blood potassium levels, especially important when using certain antihypertensives like ACE inhibitors or ARBs .
Screening for other cardiovascular risk factors including glycated haemoglobin (HbA1c), total cholesterol, and HDL cholesterol .
Examination of the fundi for hypertensive retinopathy .
Performing a 12-lead electrocardiograph (ECG) to assess cardiac status .
Monitoring for symptoms and signs of postural hypotension by measuring blood pressure both seated and standing, especially in older adults or those with symptoms ,.
Providing an annual review to discuss lifestyle, symptoms, medication adherence, and to monitor blood pressure and side effects ,.

What are the key monitoring parameters for patients starting antihypertensive therapy?