Followup Recommendation

< ยก30 130-139 140-1 59 160-179 180-209 > 7.10

Normal High normal Stage I (miid) Stage II (moderate) Stage III (severe) Stage IV (very severe)

Recheck in 2yr

Confirm within 1 mo

Evaluate/refer to source of care tu < 1 wk

Basic studies and evaluation in a new hypertensive patient include urinalysis, chemistry panel 7, EKG, and hemoglobin/hematocrit. Do not treat hypertension until you have a diagnosis (hypertension on three separate visits)! Once you have a diagnosis, first allow the patient 3-4 months of weight reduction, exercise, and other lifestyle modifications (low salt and cholesterol diet, no alcohol or smoking). If this approach is unsuccessful, only then do you start medication . There are four first-line agents for the treatment of hypertension: beta blockers, thiazide diuretics, angiotensin converting enzyme (ACE) inhibitors, and calcium channel blockers. Which one you choose is often based on the patient (see table, top of next page):

For pregnant patients, use hydralazine and/or alpha methyldopa. 1 .abet a loi is slowly gaining acceptance also. Remember that in patients with preeclampsia, magnesium sulfate lowers blood pressure. For side effects of hypertension medications (high yield), see pharmacology section.

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