25
a
Using the ACC/AHA Pooled Cohort Equations. Note that patients with diabetes mellitus
(DM )or CKD are automatically placed in the high-risk category. For initiation of renin-
angiotensin system (RAS) inhibitor or diuretic therapy, assess blood tests for electrolytes and
renal function 2–4 weeks aer initiating therapy.
b
Consider initiation of pharmacological therapy for stage 2 hypertension with 2
antihypertensive agents of different classes. Patients with stage 2 hypertension and BP
≥160/100 mm Hg should be promptly treated, carefully monitored, and subject to
upward medication dose adjustment as necessary to control BP. Reassessment includes
BP measurement, detection of orthostatic hypotension in selected patients (e.g., older or
with postural symptoms), identification of white coat hypertension or a white coat effect,
documentation of adherence, monitoring of the response to therapy, reinforcement of the
importance of adherence, reinforcement of the importance of treatment, and assistance with
treatment to achieve BP target.
Colors correspond to Class of Recommendation on page 56–57.
Follow-Up After Initial BP Evaluation
COR LOE
Recommendations
I B-R Adults with an elevated BP or stage 1 hypertension who have
an estimated 10-year ASCVD risk less than 10% should be
managed with nonpharmacological therapy and have a repeat BP
evaluation within 3 to 6 months.
I B-R Adults with stage 1 hypertension who have an estimated 10-year
ASCVD risk of 10% or higher should be managed initially with
a combination of nonpharmacological and antihypertensive drug
therapy and have a repeat BP evaluation in 1 month.
I B-R Adults with stage 2 hypertension should be evaluated by or
referred to a primary care provider within 1 month of the initial
diagnosis, have a combination of nonpharmacological and
antihypertensive drug therapy (with 2 agents of different classes)
initiated, and have a repeat BP evaluation in 1 month.
I B-R For adults with a very high average BP (e.g., SBP ≥180 mm
Hg or DBP ≥110 mm Hg ), evaluation followed by prompt
antihypertensive drug treatment is recommended.
IIa C-EO For adults with a normal BP, repeat evaluation every year is
reasonable.
Figure 4. Footnotes
