Lifestyle modifications

End

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Not at goal blood pressure (< 140/90 mm Hg) (< 130/80 mm Hg for patients with diabetes or chronic kidney disease)

Not at goal blood pressure

Optimize dosages or add additional drugs until goal blood pressure is achieved.
Consider consultation with hypertension specialist
Consider consultation with a nephrologist (https://www.uptodate.com/contents/ treatment-of-resistant-hypertension)

Drug(s) for compelling indications.(See prescriber.)
Other antihypertensive drugs (diuretics, ACE inhibitors, ARBs, beta blockers, calcium channel blockers) as needed.

Initial drug choices

Without compelling indications

With compelling indications

Stage 1 hypertension
(systolic BP 140-159 mm Hg
OR
diastolic BP 90-99 mm Hg)
Thiazide-type diuretics for most. Consider ACE inhibitors, ARBs, beta blockers, calcium channel blockers, direct renin inhibitors, or combination.

Stage 2 hypertension
(systolic BP 160 mm Hg
OR
diastolic BP 100 mm Hg)
Two-drug combination for most (usually thiazide-type diuretic and either ACE inhibitor, ARB, beta blocker, or calcium channel blocker).

Stage 2 hypertension (systolic BP >=160 mm Hg OR diastolic BP >=100 mm Hg)

Stage 2 hypertension
(systolic BP 160 mm Hg
OR
diastolic BP 100 mm Hg)
Two-drug combination for most (usually thiazide-type diuretic and either ACE inhibitor, ARB, beta blocker, or calcium channel blocker).

Stage 2 hypertension
(systolic BP 160 mm Hg
OR
diastolic BP 100 mm Hg)
Two-drug combination for most (usually thiazide-type diuretic and either ACE inhibitor, ARB, beta blocker, or calcium channel blocker).

Stage 2 hypertension Stage 2 hypertension



Stage 2 hypertension (systolic BP >=160 mm Hg OR diastolic BP >=100 mm Hg)