Red Flags
- BP ≥180/120 mmHg with end-organ involvement (chest pain, dyspnoea, neurological deficit, AKI) — hypertensive emergency requiring IV therapy[1]
- Sudden severe headache + BP elevation in pregnancy >20 weeks — preeclampsia/eclampsia[2]
- New BP ≥160/100 in a previously normotensive patient under 30 — secondary cause workup mandated[1]
- Resistant hypertension (uncontrolled on 3 agents including a diuretic) — rule out secondary causes[1]
First-line treatment
Interventions
- Lifestyle modification[1]Sodium <2.3 g/day, DASH diet, 150 min/week moderate aerobic activity, weight reduction if BMI ≥25, alcohol ≤2 drinks/day men or ≤1 drink/day women
First-line drug therapy
| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Amlodipine[1] | Calcium channel blocker (DHP) | 5–10 mg PO once daily | — | Preferred in elderly and isolated systolic hypertension |
| Telmisartan[1] | Angiotensin receptor blocker (ARB) | 40–80 mg PO once daily | 2–6 mg/kg/day (max 40 mg) | Preferred with diabetic nephropathy and proteinuria |
| Hydrochlorothiazide[1] | Thiazide diuretic | 12.5–25 mg PO once daily | — | Often combined with ACE inhibitor or ARB |
Amlodipine[1]
Calcium channel blocker (DHP)
- Adult
- 5–10 mg PO once daily
- Paediatric
- —
Preferred in elderly and isolated systolic hypertension
Telmisartan[1]
Angiotensin receptor blocker (ARB)
- Adult
- 40–80 mg PO once daily
- Paediatric
- 2–6 mg/kg/day (max 40 mg)
Preferred with diabetic nephropathy and proteinuria
Hydrochlorothiazide[1]
Thiazide diuretic
- Adult
- 12.5–25 mg PO once daily
- Paediatric
- —
Often combined with ACE inhibitor or ARB
Safety-net
Referral criteria
- BP ≥180/120 mmHg with chest pain, neurological deficit, dyspnoea, or AKIEmergency department, IV antihypertensive therapy[1]
- Resistant hypertension uncontrolled on 3 agents including a diureticCardiology or hypertension clinic[1]
- Age <30 with new hypertension OR abrupt onset OR hypokalaemia OR abdominal bruitEndocrinology and renal artery imaging[1]
- Pregnancy with BP ≥140/90Obstetric medicine[2]
Clinical summary
Diagnosis, evaluation, and pharmacological management of essential hypertension in adults aged 18 and older.
References
- 1.2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (2025)
- 2.Hypertension in pregnancy. ACOG (2024)
- 3.2024 ESC Guidelines for the management of elevated blood pressure and hypertension. European Heart Journal (2024)