If the patient is elderly, this may or may not be possible, it may well be when the patient stands up, they are dizzy, so you may have to compromise, but 140 is a reasonable target, or slightly below for an elderly patient. The pharmaceutical industry has provided us with maybe 300 medicines for high blood pressure, maybe 300, so this is every bit as daunting for you as prescribing oral contraceptives is for me. Fortunately, you don t have to know all of that. What this slide shows is that all of the classes of antihypertensive agents, diuretics, alpha blockers, beta blockers, calcium channel blockers, and ACE inhibitors all lower blood pressure at Start with a low dose diuretic or a beta blocker, they are equally effective as the new more expensive agents, they are known to provide important benefits to patient s. The lab tests you need to get are small in diuretics, basically it s basic chemistry panel and calcium because diuretics on rare occasions can elevate calcium and see the patient every two months, once their blood pressure is If you can t counsel the patient or choose not to, get your nurse to do it.
Therapy is life long for hypertension.
It is the very rare patient who will get skinny and come off medicines. It happens but it s rare. Some patient s think I finished the bottle of my Indications for referral. The patient has severe hypertension, end organ disease or some other important medical disease, it is reasonable to refer that patient to a general internist or cardiologist.