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

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) ¹,².
• Assessment of renal function by measuring serum creatinine, electrolytes, and estimated glomerular filtration rate (eGFR) ¹.
• Testing urine for albumin:creatinine ratio (ACR) to detect proteinuria ¹.
• Measurement of blood potassium levels, especially important when using certain antihypertensives like ACE inhibitors or ARBs ¹.
• Screening for other cardiovascular risk factors including glycated haemoglobin (HbA1c), total cholesterol, and HDL cholesterol ².
• Examination of the fundi for hypertensive retinopathy ².
• Performing a 12-lead electrocardiograph (ECG) to assess cardiac status ².
• Monitoring for symptoms and signs of postural hypotension by measuring blood pressure both seated and standing, especially in older adults or those with symptoms ¹,².
• Providing an annual review to discuss lifestyle, symptoms, medication adherence, and to monitor blood pressure and side effects ¹,².