simple rules to manage hypertension

Medications to control hypertension are easy to use
different categories are available, what works for one patient doesn't work for another

Age groups
<55 years and not from black origin
start ACEi , familarise yourself with one or 2 of them
Lisinopril is once daily , comes in 2.5, 5, 10 and 20 mg , review 2 weekly
ramipril is easy once daily dose, review in 2 weeks , increase dose from 1.25 to 2.5 to 5 to 10 mgs as needed
consider angiotensin II antagonists if intolerant
losartan (cozaar ) comes in 25, 50 and 100mg doses, remember it is more expensive

remember the need for monitoring renal functions 2 weeks after starting ACEi or Angiotensin II antagnoists
add thiazide if needed 12.5 mg or 25 mg
combination is available with lisinopril in the name of carace 10 plus or carace 20 plus

add calcium channel blockers if poor control
amlodipine , once daily, safe and commonly used in UK , comes in 5 mg and 10 mg doses

consider adding b-blocker, or alpha blocker if poor control

IF patient is older than 55 years old or from black african origin
start with Caclium channel blocker or diuretics and try ACEi later on and then B-blockers and alpha blockers

remember achieving normal blood pressure control might not be achievable in all cases
remember 2ry hypertension causes in younger patients, patients with rapidly rising hypertension and resistent cases
familirise yourself with common side effects of the medications you are using and inform your patient to build a trust in your relationship with them and work alongside each other
once good control is achieved review once yearly with bloods for U&E , urine dip stick for protein, fundoscopy for retinopathy and of course blood pressure reading
continue advice about life style changes


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