What are the recommended guidelines for managing hypertension in primary care?

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 ¹.

Offer lifestyle advice periodically, including promoting a healthy diet, regular exercise, weight loss if overweight, and reducing alcohol and caffeine intake ¹.

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 ¹.

Advise and support smoking cessation and inform about local initiatives supporting healthy lifestyle changes ¹.

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 ¹.

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 ¹.

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 ¹.

Perform investigations for target organ damage, including urine tests, blood tests, fundi examination, and ECG, at diagnosis and during management ².

Review blood pressure control and medication adherence periodically, especially when treatment is escalated or changed ².

In cases of resistant hypertension, confirm elevated blood pressure with ambulatory or home monitoring, assess adherence, and consider specialist referral for further management ².