What are the current guidelines for the management of hypertension in primary care?

In primary care, the current guidelines recommend measuring blood pressure accurately, ensuring proper technique, device validation, and a relaxed environment for measurement ².

Diagnosis of hypertension involves measuring blood pressure in both arms, with repeat measurements if differences are significant, and confirming with ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) if readings are between 140/90 mmHg and 180/120 mmHg ².

For adults aged under 80 years, the target blood pressure is below 140/90 mmHg, and for those aged 80 and over, below 150/90 mmHg, with clinical judgment used for frail or multimorbid patients ².

Management includes offering lifestyle advice such as a healthy diet, regular exercise, weight loss if overweight, reducing alcohol and caffeine intake, and low dietary sodium, along with smoking cessation support ¹,².

When initiating drug treatment, first-line options depend on age, ethnicity, and comorbidities: ACE inhibitors or ARBs for those under 55 years not of black African or Caribbean origin, and calcium-channel blockers or thiazide-like diuretics for those aged 55 and over or of black African/Caribbean origin ¹.

Additional medications such as beta-blockers or alpha-blockers may be considered in resistant cases, with specialist referral if blood pressure remains uncontrolled despite optimal treatment ¹.

Regular review of blood pressure, medication adherence, and lifestyle is recommended, with adjustments made based on response and tolerability ².