🩺 General MedicineCardiovascularStudentInternResident

Hypertension

Also known as: high blood pressure · raised BP · HTN

Persistently raised arterial pressure (≥140/90 mmHg) — a leading, modifiable cause of stroke, heart attack, heart failure and kidney disease.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Adults; risk rises with age, excess salt, overweight, physical inactivity, alcohol, tobacco, family history, diabetes and CKD. Usually asymptomatic — the “silent killer”, so screening matters.

Red flags — escalate / refer

BP ≥180/120 mmHg WITH symptoms (chest pain, breathlessness, focal neurological deficit, severe headache, visual loss) = hypertensive emergency → treat/refer urgently.
Pregnancy with high BP ± proteinuria, headache, epigastric pain or visual symptoms → suspect pre-eclampsia; refer.
Very young onset, resistant BP or hypokalaemia → look for a secondary cause.

Work-up / diagnosis

1Confirm the diagnosis: raised office BP on ≥2 readings across ≥2 visits (or home/ambulatory monitoring). Use correct cuff size and technique; sit rested, arm supported.
2Assess total cardiovascular risk, not just the number: age, smoking, diabetes, lipids, family history.
3Screen for target-organ damage: fundoscopy, ECG (LVH), urine protein/ACR, serum creatinine + eGFR.
4Baseline labs: electrolytes, fasting glucose/HbA1c, lipid profile, renal function, urinalysis.
5Consider secondary causes if young, resistant, or with suggestive features.

Management — overview

Lifestyle for EVERYONE: reduce salt to <5 g/day, DASH-style diet rich in fruit/vegetables, weight reduction, ≥150 min/week activity, limit alcohol, stop tobacco.
Start drug therapy based on BP level and overall CV risk; most patients need ≥2 drugs — a low-dose two-drug combination is preferred to reach target faster.
First-line drug classes: thiazide/thiazide-like diuretic, ACE inhibitor OR ARB, and long-acting dihydropyridine calcium-channel blocker (e.g. amlodipine).
Do not combine an ACE inhibitor with an ARB. Review every 2–4 weeks until controlled, then periodically.
Target generally <140/90 mmHg; consider <130/80 mmHg in high-risk patients if well tolerated (individualise).

In-depthFull dosing & advanced protocol

Drug dosing

Amlodipine (dihydropyridine CCB)

First-line antihypertensive

Adult dose: 5 mg once daily, up-titrate to 10 mg once daily
Route: Oral

Caution: Ankle oedema; avoid abrupt combination pitfalls — check the source for the current step-care.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Telmisartan (ARB) — or an ACE inhibitor (e.g. enalapril)

First-line; preferred in diabetes/CKD (proteinuria)

Adult dose: Telmisartan 40 mg once daily, up to 80 mg (enalapril 5 mg → up to 20 mg BD)
Route: Oral
Population: Avoid in pregnancy

Caution: Check K⁺ and renal function 1–2 weeks after starting/increasing; contraindicated in pregnancy.

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Hydrochlorothiazide / Chlortalidone (thiazide-type diuretic)

First-line, often as combination partner

Adult dose: 12.5–25 mg once daily
Route: Oral

Caution: Monitor Na⁺/K⁺ and glucose; use lower doses in the elderly.

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Special populations

Pregnancy: use labetalol, methyldopa or nifedipine; NEVER ACE inhibitors/ARBs. Escalate pre-eclampsia per obstetric protocol.
Diabetes / CKD with albuminuria: prefer an ACE inhibitor or ARB as the anchor drug.
Black African ancestry or age >60 without compelling indication: a CCB or thiazide is often a better first step than ACEi/ARB alone.
Resistant hypertension (uncontrolled on 3 drugs incl. a diuretic): add spironolactone and re-check adherence + secondary causes.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Monitoring & follow-up

Recheck BP and side-effects every 2–4 weeks while titrating; then every 3–6 months once stable.
Repeat renal function/electrolytes after starting or increasing an ACEi/ARB or diuretic.
Reinforce lifestyle at every visit; assess adherence before adding drugs.

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

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Hypertension

Also known as: high blood pressure · raised BP · HTN

Persistently raised arterial pressure (≥140/90 mmHg) — a leading, modifiable cause of stroke, heart attack, heart failure and kidney disease.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

Red flags — escalate / refer

BP ≥180/120 mmHg WITH symptoms (chest pain, breathlessness, focal neurological deficit, severe headache, visual loss) = hypertensive emergency → treat/refer urgently.

Pregnancy with high BP ± proteinuria, headache, epigastric pain or visual symptoms → suspect pre-eclampsia; refer.

Very young onset, resistant BP or hypokalaemia → look for a secondary cause.

Work-up / diagnosis

1Confirm the diagnosis: raised office BP on ≥2 readings across ≥2 visits (or home/ambulatory monitoring). Use correct cuff size and technique; sit rested, arm supported.

2Assess total cardiovascular risk, not just the number: age, smoking, diabetes, lipids, family history.

3Screen for target-organ damage: fundoscopy, ECG (LVH), urine protein/ACR, serum creatinine + eGFR.

4Baseline labs: electrolytes, fasting glucose/HbA1c, lipid profile, renal function, urinalysis.

5Consider secondary causes if young, resistant, or with suggestive features.

Management — overview

Lifestyle for EVERYONE: reduce salt to <5 g/day, DASH-style diet rich in fruit/vegetables, weight reduction, ≥150 min/week activity, limit alcohol, stop tobacco.

Start drug therapy based on BP level and overall CV risk; most patients need ≥2 drugs — a low-dose two-drug combination is preferred to reach target faster.

First-line drug classes: thiazide/thiazide-like diuretic, ACE inhibitor OR ARB, and long-acting dihydropyridine calcium-channel blocker (e.g. amlodipine).

Do not combine an ACE inhibitor with an ARB. Review every 2–4 weeks until controlled, then periodically.

Target generally <140/90 mmHg; consider <130/80 mmHg in high-risk patients if well tolerated (individualise).

Drug dosing

Amlodipine (dihydropyridine CCB)

First-line antihypertensive

Adult dose: 5 mg once daily, up-titrate to 10 mg once daily
Route: Oral

Caution: Ankle oedema; avoid abrupt combination pitfalls — check the source for the current step-care.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Telmisartan (ARB) — or an ACE inhibitor (e.g. enalapril)

First-line; preferred in diabetes/CKD (proteinuria)

Adult dose: Telmisartan 40 mg once daily, up to 80 mg (enalapril 5 mg → up to 20 mg BD)
Route: Oral
Population: Avoid in pregnancy

Caution: Check K⁺ and renal function 1–2 weeks after starting/increasing; contraindicated in pregnancy.

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Hydrochlorothiazide / Chlortalidone (thiazide-type diuretic)

First-line, often as combination partner

Adult dose: 12.5–25 mg once daily
Route: Oral

Caution: Monitor Na⁺/K⁺ and glucose; use lower doses in the elderly.

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Special populations

Pregnancy: use labetalol, methyldopa or nifedipine; NEVER ACE inhibitors/ARBs. Escalate pre-eclampsia per obstetric protocol.

Diabetes / CKD with albuminuria: prefer an ACE inhibitor or ARB as the anchor drug.

Black African ancestry or age >60 without compelling indication: a CCB or thiazide is often a better first step than ACEi/ARB alone.

Resistant hypertension (uncontrolled on 3 drugs incl. a diuretic): add spironolactone and re-check adherence + secondary causes.

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Amlodipine (dihydropyridine CCB)

Telmisartan (ARB) — or an ACE inhibitor (e.g. enalapril)

Hydrochlorothiazide / Chlortalidone (thiazide-type diuretic)

📈 Special populations

📈 Monitoring & follow-up

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Amlodipine (dihydropyridine CCB)

Telmisartan (ARB) — or an ACE inhibitor (e.g. enalapril)

Hydrochlorothiazide / Chlortalidone (thiazide-type diuretic)

📈 Special populations

📈 Monitoring & follow-up

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Special populations

Monitoring & follow-up

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Special populations

Monitoring & follow-up

References