Cardiology · ICMR

Hypertension in adults

ICMR

Source:Indian Guidelines on Hypertension (IGH-IV, 2019) and India Hypertension Control Initiative (IHCI) Standard Treatment Workflow

Verified Apr 2026

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Red Flags

BP ≥180/120 mmHg with chest pain, dyspnoea, neurological deficit, severe headache, or AKI — hypertensive emergency, immediate IV therapy^[1]
BP ≥160/110 in pregnancy ≥20 weeks with proteinuria, severe headache, visual symptoms, or epigastric pain — preeclampsia/eclampsia^[1]
Resistant hypertension (uncontrolled on 3 agents including a diuretic at maximum tolerated doses) — secondary cause workup^[1]
New BP ≥160/100 in a previously normotensive patient under 30 — investigate for secondary cause^[1]

First-line treatment

Interventions

Lifestyle modification^[1]
Salt reduction <5 g/day, DASH-style diet, ≥150 minutes/week moderate aerobic activity, weight reduction if overweight, alcohol limitation, smoking cessation
Dual therapy initiation^[1]
Start two-agent combination from outset when BP ≥160/100 mmHg or ≥20/10 mmHg above target; single-pill combination preferred for adherence

First-line drug therapy

Drug	Class	Adult	Paediatric	Notes
Amlodipine^[1]	Calcium channel blocker (DHP)	5–10 mg PO once daily	—	Preferred initial agent in IHCI primary-care workflow; effective across age groups including elderly
Telmisartan^[1]	Angiotensin receptor blocker (ARB)	40–80 mg PO once daily	—	Preferred with diabetes, microalbuminuria, or chronic kidney disease
Hydrochlorothiazide or chlorthalidone^[1]	Thiazide / thiazide-like diuretic	12.5–25 mg PO once daily	—	Combination partner; chlorthalidone has stronger trial evidence than hydrochlorothiazide
Enalapril^[1]	ACE inhibitor	5–40 mg PO daily, divided BD if higher dose	—	Alternative to ARB; switch to ARB if cough develops

Amlodipine^[1]

Calcium channel blocker (DHP)

Adult: 5–10 mg PO once daily
Paediatric: —

Preferred initial agent in IHCI primary-care workflow; effective across age groups including elderly

Telmisartan^[1]

Angiotensin receptor blocker (ARB)

Adult: 40–80 mg PO once daily
Paediatric: —

Preferred with diabetes, microalbuminuria, or chronic kidney disease

Hydrochlorothiazide or chlorthalidone^[1]

Thiazide / thiazide-like diuretic

Adult: 12.5–25 mg PO once daily
Paediatric: —

Combination partner; chlorthalidone has stronger trial evidence than hydrochlorothiazide

Enalapril^[1]

ACE inhibitor

Adult: 5–40 mg PO daily, divided BD if higher dose
Paediatric: —

Alternative to ARB; switch to ARB if cough develops

Safety-net

Take medication every day even when feeling well — hypertension is silent until target organs are damaged^[1]
Sudden severe headache, chest pain, vision changes, slurred speech, or one-sided weakness — call emergency services immediately^[1]
Bring your BP record to every visit; home BP measurement (1 week, twice daily) helps detect white-coat hypertension and confirm control^[1]

Referral criteria

BP ≥180/120 mmHg with end-organ involvementEmergency department for IV antihypertensive and end-organ workup^[1]
Resistant hypertension uncontrolled on 3 agents including a diureticHypertension or cardiology clinic for secondary cause workup^[1]
Pregnancy with BP ≥140/90 mmHg, especially with proteinuria or symptomsObstetric medicine same-day^[1]
Age <30 with new hypertension OR hypokalaemia OR abdominal bruit OR abrupt onsetEndocrinology or nephrology for secondary cause workup^[1]

Clinical summary

Diagnosis, evaluation, and pharmacological management of essential hypertension per Indian national guidance, with primary-care emphasis.

References

1.Indian Guidelines on Hypertension (IGH-IV, 2019) and India Hypertension Control Initiative (IHCI) Standard Treatment Workflow (2019)

Drug

Class

Adult

Paediatric

Notes