Simple blood pressure guidelines for primary health care

Four simple pragmatic rules are proposed to facilitate the management of essential hypertension in the context of primary care. Rule 1: Abandon diastolic blood pressure measurement and rely on systolic blood pressure values for decisions on treatment thresholds and goals. Rule 2: Assess overall cardiovascular risk by history taking, physical examination and simple investigation (urine dipsticks, serum creatinine, glucose, lipids and ECG). Rule 3: As a generality, apply a systolic threshold of 150 mm Hg for the introduction of drug treatment when repeated measures of blood pressure following a trial of non-pharmacological treatment, remain persistently above this level. This threshold may be reduced to 140 mm Hg for higher risk patients (eg, those with target organ damage or diabetes) or raised to 160 mm Hg for low risk patients and the elderly. Rule 4: Modify therapy if initial drug treatment is ineffective, partially effective or poorly tolerated. If blood pressure does not fall below the treatment threshold, drug dosage should be increased (except diuretics), treatment changed or combinations used to achieve goal pressures.