In primary care, the management of hypertension involves a combination of lifestyle interventions and pharmacological treatment, with regular monitoring of blood pressure to achieve target levels NICE CKS.
Offer lifestyle advice periodically, including promoting a healthy diet, regular exercise, weight loss if overweight, and reducing alcohol and caffeine intake NICE CKS.
Encourage low dietary sodium intake, but avoid salt substitutes containing potassium chloride in older people, those with diabetes, pregnant women, and individuals with kidney disease or on certain antihypertensives NICE CKS.
Advise and support smoking cessation and inform about local initiatives supporting healthy lifestyle changes NICE CKS.
For pharmacological treatment, first-line options depend on age, ethnicity, and comorbidities: for those under 55 years and not of black African or African-Caribbean origin, an ACE inhibitor or ARB is recommended; for those aged 55 and over, or of black African or Caribbean origin, a calcium-channel blocker or thiazide-like diuretic is preferred NICE CKS.
When blood pressure remains uncontrolled, stepwise addition of other antihypertensive agents such as CCBs, thiazide-like diuretics, or combination therapy is advised, with titration to the highest tolerated dose NICE CKS.
Monitor response to treatment regularly, aiming for blood pressure below 140/90 mmHg in adults under 80, and below 150/90 mmHg in those aged 80 and over, adjusting for frailty or multimorbidity based on clinical judgment NICE CKS.
Perform investigations for target organ damage, including urine tests, blood tests, fundi examination, and ECG, at diagnosis and during management NICE NG136.
Review blood pressure control and medication adherence periodically, especially when treatment is escalated or changed NICE NG136.
In cases of resistant hypertension, confirm elevated blood pressure with ambulatory or home monitoring, assess adherence, and consider specialist referral for further management NICE NG136.