VA/DoDCLINICAL PRACTICE GUIDELINE FOR

THE DIAGNOSIS AND MANAGEMENT OF

HYPERTENSION IN THE PRIMARY CARE

SETTING

Department of Veterans Affairs

Department of Defense

Patient Guide

Version 1.0 – 2014

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Hypertension

One in three Americans has high blood pressure (hypertension). If it is not treated, hypertension can harm

the blood vessels. This can cause stroke, heart attack, kidney disease and heart failure.

Did You Know?

• 1 Only 8 in 10 people with hypertension know that they have it.

• Only one in two people with hypertension hasit under control with 1 medicine.

• 2 13% of active military personnel have hypertension.

• 3 Combat exposures can increase the risk for hypertension.

• More than one in three Veterans has hypertension. This is the most 4 Veterans.frequent chronic condition for

Why Do People Have Hypertension?

Often, we don’t know why people have hypertension. However, family history, foods, body fat, and not 

enough physical activity can raise blood pressure. This is called “primary hypertension.” Some 

medicines, illegal drug use, alcohol, kidney problems, or breathing problems can also raise blood 

pressure. This is called “secondary hypertension.” 

Some people are at risk for hypertension. For example:

• People older than 60 years

• Overweight people

• Smokers

• Men (vs. women)

• African Americans

• People with diabetes or kidney disease

How Do I Know ifI Have Hypertension?

People cannot feel that they have high blood pressure. They don’t feelsick. So your doctor will measure

your blood pressure every time he or she sees you. If it seemsthat you have high blood pressure, your

doctor will measure several times or ask you to come back to make sure it is true.

Your doctor may also ask you to measure your blood pressure yourself at home. Or he orshe may ask you

to go home with a machine that measures blood pressure for 24 hours.

Questionsto ask your provider if you are

diagnosed with hypertension:

1. What is my blood pressure goal?

2. Isthere any chance I could have

secondaryhypertension?

3. Whatside effects can I expect from my

medication?

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If you have high blood pressure, your doctor will ask you more questions and may do some tests:

• A urine test

• A blood test

• An electrocardiogram (ECG)

How Can I Treat My Hypertension?

Changing food and physical activity habits help treat hypertension.

But often you will also need medications. It is a chronic disease, so

you will need treatment for a long time. When you start treatment,

you may have to see your provider often to adjust treatment.

Things you can do to reduce blood pressure:

• Lose weight.

• Increase physical activity.

• Change the foods you eat. For example, eat lessfood that

contains a lot of salt.

• Drink less alcohol.

• Stop using tobacco.

• Reduce stress.

There are many medications to treat hypertension. If you need them,

your doctor will work with you to find the best medicine for you.

Often you will need more than one pill.

Where Can I Find More Information?

NationalHeart, Blood and Lung Institute: http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/

AmericanHeartAssociation:http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/AboutHigh-Blood-Pressure_UCM_002050_Article.jsp

Centersfor Disease Control and Prevention: http://www.cdc.gov/bloodpressure/

Frequently Asked Questions:

I don’t feelsick. Why do I need to take

medication?

People with high blood pressure don’t feel

sick. But it can still cause heart failure,

stroke and kidney disease. Because there

are no symptoms, hypertension has been

nicknamed the “silent killer.”

Why do I need to see my provider so

often?

It may take several monthsto adjust your

treatment to reach goal blood pressure

levels.

My blood pressure is controlled. Can I

stoptreatment?

No, hypertension treatment needsto

continue to keep blood pressure under

control. Speak to your provider before

discontinuing any part of yourtreatment.

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References

1. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2013 update: A report

from the American Heart Association. Circulation. Jan 1 2013;127(1):e6-e245.

2. Smoley BA, Smith NL, Runkle GP. Hypertension in a population of active duty service members. J

Am Board Fam Med. Nov-Dec 2008;21(6):504-511.

3. Granado NS, Smith TC, Swanson GM, et al. Newly reported hypertension after military combat

deployment in a large population-based study. Hypertension. Nov 2009;54(5):966-973.

4. VA Health Services Research & Development. Spotlight: Hypertension and Stroke.

http://www.hsrd.research.va.gov/news/feature/hypertension_stroke.cfm. Updated June 2011.

Accessed October 27, 2014.

Qualifying Statements

The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best

information available at the time of publication. They are designed to provide information and assist

decision-making. They are not intended to define a standard of care and should not be construed as one.

Neithershould they be interpreted as prescribing an exclusive course of management.

This Clinical Practice Guideline is based on a systematic review of both clinical and epidemiological

evidence. Developed by a panel of multidisciplinary experts, it provides a clear explanation of the logical

relationships between various care options and health outcomes while rating both the quality of the

evidence and the strength of the recommendations.

Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of

individual patients, available resources, and limitations unique to an institution or type of practice. Every

healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of

applying them in the setting of any particular clinicalsituation.

These guidelines are not intended to represent TRICARE policy. Further, inclusion of recommendations for

specific testing and/or therapeutic interventions within these guidelines does not guarantee coverage of

civilian sector care. Additional information on current TRICARE benefits may be found atwww.tricare.mil

or by contacting your regional TRICARE Managed Care Support Contractor.

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