Hypertension in adults

Red Flags

BP ≥180/120 mmHg with chest pain, dyspnoea, neurological deficit, severe headache, or AKI — hypertensive emergency, immediate parenteral 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 maximally tolerated doses) — investigate secondary causes^[1]
New BP ≥160/100 in a previously normotensive patient under 30 — secondary cause workup^[1]

First-line treatment

Interventions

Lifestyle modification^[1]
Salt reduction <5 g/day, fruit-and-vegetable-rich diet, ≥150 minutes/week moderate aerobic activity, weight reduction if overweight, alcohol limitation, smoking cessation, stress management
Opportunistic screening^[1]
Measure BP at every healthcare contact in adults ≥18; targeted community screening for adults >50, diabetics, obese, family history of hypertension
Stepwise pharmacotherapy escalation^[1]
Start single agent for grade 1 HTN with low overall risk; dual therapy from outset for BP ≥160/100 or ≥20/10 above target; triple therapy if uncontrolled at 4–6 weeks

First-line drug therapy

Drug	Class	Adult	Paediatric	Notes
Amlodipine^[1]	Calcium channel blocker (DHP)	5–10 mg PO once daily	—	First-line in IHCI primary-care workflow; widely available across PHCs and CHCs
Enalapril^[1]	ACE inhibitor	5–40 mg PO daily, divided BD if higher dose	—	Alternative first-line; switch to ARB if cough develops
Telmisartan^[1]	Angiotensin receptor blocker (ARB)	40–80 mg PO once daily	—	Preferred with diabetes, microalbuminuria, or chronic kidney disease
Hydrochlorothiazide^[1]	Thiazide diuretic	12.5–25 mg PO once daily	—	Combination partner with CCB or ACE-i/ARB; cost-effective

Amlodipine^[1]

Calcium channel blocker (DHP)

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

First-line in IHCI primary-care workflow; widely available across PHCs and CHCs

Enalapril^[1]

ACE inhibitor

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

Alternative first-line; switch to ARB if cough develops

Telmisartan^[1]

Angiotensin receptor blocker (ARB)

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

Preferred with diabetes, microalbuminuria, or chronic kidney disease

Hydrochlorothiazide^[1]

Thiazide diuretic

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

Combination partner with CCB or ACE-i/ARB; cost-effective

Safety-net

Take medication every day even when feeling well — hypertension causes no symptoms 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 mmHg with end-organ involvementEmergency department for parenteral antihypertensive and end-organ workup^[1]
Resistant hypertension uncontrolled on 3 agents at maximally tolerated dosesCardiology or hypertension 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 bruitEndocrinology or nephrology for secondary cause workup^[1]

Clinical summary

Primary-care management of hypertension per India's national Standard Treatment Guidelines, with opportunistic screening and stepwise pharmacotherapy.

References

1.MoHFW Standard Treatment Guidelines — Hypertension; India Hypertension Control Initiative (IHCI) Standard Treatment Workflow (2021)