/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/cpg/,/clinical/cckm-tools/content/cpg/cardiovascular/,/clinical/cckm-tools/content/cpg/cardiovascular/related/,

/clinical/cckm-tools/content/cpg/cardiovascular/related/name-100416-en.cckm

201607191

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Clinical Practice Guidelines,Cardiovascular,Related

Flowchart for Initiation and Titration of Antihypertensive Medication

Flowchart for Initiation and Titration of Antihypertensive Medication - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Cardiovascular, Related


Office blood pressure > 140/90 mmHg in
adults aged 18 years or older
(Recommended to confirm diagnosis with readings
outside of the clinic)
Start Lifestyle Modifications
(e.g., weight loss, physical activity, DASH-sodium diet, smoking cessation)
Stage 1 Drug Therapy
(140-159/90-99 mmHg)
(Consider a delay in uncomplicated Stage 1 patients*)
All Patients
Stage 2 Drug Therapy
(> 160/100 mmHg)
Special Cases
ξ Kidney disease
ξ Diabetes
ξ Coronary disease
ξ Stroke history
ξ Heart failure
See Tables 6 and 7
Black Patients
Non-Black
Patients
Age < 60
years?
ACE-I or ARB
Yes
CCB or Thiazide
No
ACE-I or ARB
If needed, add...
CCB + Thiazide + ACE-I (or ARB)
If needed...
CCB or Thiazide
If needed, add...
CCB or Thiazide
ACE-I or ARB
OR
combine CCB + Thiazide
If needed, add...
If needed...
Start with 2 drugs
CCB or Thiazide
+
ACE-I or ARB
If needed...
Add other drugs (e.g., spironolactone; centrally acting agents; β-blockers)
If needed, add...
Refer to Hypertension Specialist
If needed...
*Six months of monitored
lifestyle modifications may be
considered in patients with
Stage 1 hypertension, without
other cardiovascular risk factors
or target organ damage, prior
to initiating antihypertensive
medications.
CCB: calcium channel blocker; ACE-I: angiotensin-converting enzyme
inhibitors; ARB: angiotensin receptor blocker
References:
UW Health Hypertension – Adult – Ambulatory Clinical Practice Guideline
Figure adapted from Weber MA, et al. Clinical practice guidelines for the
management of hypertension in the community: a statement by the
American Society of Hypertension and the International Society of
Hypertension. 2014;16:14-26
Initiation and Treatment of
Antihypertensive Medications
If needed...
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org