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ClearRounds Health · Cardiology · Quick Reference
Hypertension
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Prevention & Risk ReductionAllAvailableOne-page PDF
Practical HTN diagnosis, BP targets, medication classes, resistant HTN, secondary causes, monitoring, and clinic workflow.
Last reviewed
July 17, 2026
Sources / guidelines to verify
- 2025 AHA/ACC High Blood Pressure Guideline (universal target <130/80; PREVENT risk)
- Local formulary & BP measurement protocol
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.
One-page reference
Clinically reviewed by the site owner. Still verify against the sources above and local protocol before clinical use.
1
What it is / why it matters
- The leading modifiable cardiovascular risk factor.
- Universal treatment target is <130/80 mmHg.
2
Key diagnostic clues
| Category | BP (mmHg) |
|---|---|
| Normal | <120 and <80 |
| Elevated | 120–129 and <80 |
| Stage 1 | 130–139 or 80–89 |
| Stage 2 | ≥140 or ≥90 |
- Confirm the diagnosis with averaged, properly measured readings and out-of-office (home or ambulatory) values.
3
Initial workup
- Labs: BMP/eGFR, urinalysis with albumin:creatinine, lipids, HbA1c, TSH; ECG.
- Estimate 10-yr risk with PREVENT.
- Screen for secondary causes when clinical clues are present.
4
Management framework
Lifestyle (everyone)
- DASH diet, sodium reduction
- Weight loss, physical activity
- Limit alcohol, increase dietary potassium
When to add drug therapy
- Stage 1: add a medication if ASCVD, diabetes, CKD, or PREVENT 10-yr risk ≥7.5%
- Stage 2: lifestyle + drug therapy, usually two agents (single-pill combination preferred)
First-line agents
- Thiazide (chlorthalidone preferred)
- ACE inhibitor or ARB (not both)
- Dihydropyridine CCB
Resistant HTN (uncontrolled on 3 drugs incl. a diuretic)
- Confirm adherence and measurement technique
- Add an MRA (spironolactone)
- Screen for primary aldosteronism
- Renal denervation is an adjunct option
5
Red flags / escalate now
- Hypertensive emergency = severe BP + target-organ damage (ACS, aortic dissection, pulmonary edema, AKI, neurologic changes, eclampsia) → emergent care.
- Secondary clues: young onset, abrupt or resistant HTN, unprovoked hypokalemia.
6
Follow-up / monitoring
- Encourage home BP monitoring; recheck ~2–4 weeks after changes.
- BMP after starting/adjusting ACEi/ARB, diuretic, or MRA.
- Team-based care improves control rates.
7
Clinic pearls
- 2025 guidance expands primary-aldosteronism screening to ALL stage 2 / resistant HTN.
- Chlorthalidone outperforms HCTZ for outcomes.
- Single-pill combinations improve adherence; correct cuff size and positioning prevent false readings.
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