Essential Hypertension [2014 update]
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- accurately diagnose hypertension,
- improve blood pressure (BP) control,
- decrease hypertension-related morbidity and mortality,
- encourage patient's self-involvement,
- provide appropriate education and follow-up, and
- provide cost-effective care.
New aspects of care addressed in this update include:
- Options for preferred initial drug treatment have expanded beyond thiazide diuretics to include calcium channel blockers and ACE inhibitors.
- Earlier initiation of dual antihypertensive medications is emphasized, particularly with calcium channel blocker and renin/angiotensin system inhibitor (e.g., ACE inhibitor).
- Systolic and diastolic BP control for patients with diabetes and chronic kidney disease is less strict, with the target systolic BP now < 140 mmHg (instead of < 130) and diastolic BP < 90 mmHg, although diastolic BP < 80 mmHg may still be considered.
Key aspects of care are:
- Diagnosis is best using mean BP levels over several visits, and careful calibration of the BP monitor.
- Target for BP therapy is:
- < 140/90 mm Hg for patients
- Age 18 to 59 years without diabetes or renal insufficiency
- Age ≥ 18 years with diabetes, renal disease, cardiovascular disease or cerebrovascular disease
- < 150/90 for patients aged 60 years or older without diabetes, renal disease, cardiovascular disease or cerebrovascular disease.
- < 140/90 mm Hg for patients
- Thiazide diuretics, calcium channel blockers and ACE inhibitors are generally the preferred initial drug treatment.
- Add second and third agents as needed. The combination of calcium channel blocker and renin/angiotensin system inhibitor (e.g., ACE inhibitors, angiotensin receptor blocker) is increasingly viewed as the drug combination of choice.
- Patient education and self-management are fundamental to successful therapy.
The University of Michigan Medical School designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Release Date:May 2014
Termination Date: June 2022
Continued availability of CME credit for this activity depends on a thorough review of its content every three years. This activity was last reviewed for currency and accuracy in June 2019, and availability of CME credit continued.
Masahito Jimbo, MD; Family Medicine
Michael P Dorsch, PharmD; Pharmacy
Mark W Ealovega, MD; General Medicine
R Van Harrison, PhD; Medical Education
Kenneth A Jamerson, MD; Cardiovascular Medicine
Financial Disclosure Information:
Michael P Dorsch, PharmD
Speakers Bureau: Astra/Zeneca, Boehringer Ingelheim, Jansen
Kenneth Jamerson, MD
Research support, Consultant, Speakers Bureau: Novartis, Astra/Zeneca, Boehringer Ingelheim, Novartis, Takeda, Daiich Sankyo
There are no other relevant financial relationships to disclose for this CME activity.
UMHS Guidelines Oversight Team:
Karl T. Rew, MD
R. Van Harrison, PhD
Literature Search Services:
Taubman Medical Library