Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Investigation Approach:
- Measure blood pressure in both arms initially; if a difference greater than 15 mmHg persists, use the arm with the higher reading for subsequent measurements.
- Confirm hypertension diagnosis with ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) if clinic readings are between 140/90 mmHg and 180/120 mmHg.
- Conduct baseline investigations including urine albumin:creatinine ratio and haematuria testing, blood tests for HbA1c, electrolytes, creatinine, eGFR, total and HDL cholesterol, fundoscopic examination for hypertensive retinopathy, and a 12-lead ECG.
- Assess cardiovascular risk formally using an appropriate risk assessment tool.
Management Approach:
- Offer lifestyle advice focusing on healthy diet, regular exercise, reduced alcohol intake, smoking cessation, and salt reduction, tailored to the patient's context.
- Avoid potassium-containing salt substitutes due to potential risks in patients on ACE inhibitors or ARBs.
- Initiate antihypertensive drug treatment considering the patient's ethnicity; for Afro-Caribbean patients, calcium channel blockers are often first-line therapy.
- Monitor blood pressure regularly and adjust treatment to achieve target blood pressure levels.
- Consider specialist referral if postural hypotension symptoms persist or if secondary causes of hypertension are suspected.