Hypertension in adults

Red Flags

BP ≥180/120 mmHg with new neurological deficit, chest pain, dyspnoea, severe headache, or AKI — hypertensive emergency, immediate parenteral therapy^[1]
Severe hypertension (≥160/110) in pregnancy with proteinuria, severe headache, visual symptoms, or epigastric pain — preeclampsia/eclampsia^[1]
Resistant hypertension uncontrolled on ≥3 agents at maximally tolerated doses including a diuretic — investigate secondary causes^[1]
Stage 2 HTN (≥160/100) in young adult under 30 — workup for secondary cause^[1]

First-line treatment

Interventions

Single-pill combination^[1]
Two-agent fixed-dose combination preferred from initiation when BP ≥160/100 mmHg or ≥20/10 above target — improves adherence and time to control
Lifestyle modification^[1]
Salt reduction <5 g/day, plant-based diet, ≥150 minutes/week moderate aerobic activity, weight reduction if overweight, alcohol moderation, smoking cessation

First-line drug therapy

Drug	Class	Adult	Paediatric	Notes
Amlodipine^[1]	Calcium channel blocker (DHP)	5–10 mg PO once daily	—	Essential-level first-line; widely available globally; effective across age groups
Telmisartan or losartan^[1]	Angiotensin receptor blocker (ARB)	Telmisartan 40–80 mg or losartan 50–100 mg PO once daily	—	First-line in diabetes, microalbuminuria, or chronic kidney disease
Hydrochlorothiazide^[1]	Thiazide diuretic	12.5–25 mg PO once daily	—	Essential-level diuretic; combination partner with CCB or ARB
Enalapril^[1]	ACE inhibitor	5–40 mg PO once or twice daily	—	Alternative to ARB; switch to ARB if dry cough develops

Amlodipine^[1]

Calcium channel blocker (DHP)

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

Essential-level first-line; widely available globally; effective across age groups

Telmisartan or losartan^[1]

Angiotensin receptor blocker (ARB)

Adult: Telmisartan 40–80 mg or losartan 50–100 mg PO once daily
Paediatric: —

First-line in diabetes, microalbuminuria, or chronic kidney disease

Hydrochlorothiazide^[1]

Thiazide diuretic

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

Essential-level diuretic; combination partner with CCB or ARB

Enalapril^[1]

ACE inhibitor

Adult: 5–40 mg PO once or twice daily
Paediatric: —

Alternative to ARB; switch to ARB if dry 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 helps confirm control between clinic visits^[1]

Referral criteria

BP ≥180/120 with end-organ involvementEmergency department for parenteral 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 mmHgObstetric 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

Resource-stratified hypertension management designed for global use, distinguishing essential (minimum) and optimal care recommendations.

References

1.2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020)

Drug

Class

Adult

Paediatric

Notes