Hypertension: investigations and starting treatment
Identify risk factors and concomitant diseases and calculate total cardiovascular risk. The aim is to reduce the total cardiovascular risk. Motivate the patient to make lifestyle changes, which may lower blood pressure (BP) and reduce other risk factors. Exclude secondary hypertension. Start drug treatment if systolic BP is = 160 mmHg or diastolic BP = 100 mmHg. A lower threshold (140/90) is used in diabetes, renal disease, target organ damage, clinically significant cardiovascular disease and when the patient’s risk of fatal cardiovascular disease remains high (= 5%/10 years according to the SCORE risk chart ) despite lifestyle changes and modification of other risk factors. The goal of treatment is to reduce systolic BP to below 140 mmHg and diastolic pressure to below 85 mmHg. The target BP is lower if the patient has diabetes, renal disease or a history of a stroke or myocardial infarction.