Recommendations on the diagnosis and treatment of hypertension in primary care
| Recommendation | Strength of recommendation | Certainty of evidence |
|---|---|---|
| Diagnosis | ||
| BP assessment with a validated automated device and using a standardized method is recommended. | Strong | Moderate |
| Out-of-office BP assessment is recommended to confirm the diagnosis of hypertension or to detect white-coat hypertension and masked hypertension. | Strong | Moderate |
| The definition of hypertension in adults is recommended as BP ≥ 130/80 mm Hg when measured with a validated device under optimal conditions. | Strong | Moderate |
| Treatment | ||
| Healthy lifestyle changes are recommended for all adults with hypertension. | Strong | High |
| Pharmacotherapy initiation for hypertension is recommended for adults with BP ≥ 140/90 mm Hg and for adults with systolic BP 130–139 mm Hg at high cardiovascular disease risk. | Strong | High |
| Treatment, including healthy lifestyle changes with or without pharmacotherapy, is recommended for adults with hypertension to achieve a target systolic BP < 130 mm Hg, provided the treatment is well tolerated. | Strong | High |
| For adults with hypertension requiring pharmacotherapy, low-dose combination therapy (ideally as a single-pill combination) is recommended as initial treatment, which includes drugs from 2 of the following 3 complementary classes of medications: ACEIs or ARBs, thiazide or thiazide-like diuretics, and long-acting dihydropyridine CCBs. | Strong | Moderate |
| If BP remains above target despite 2-drug combination therapy, 3-drug combination therapy consisting of an ACEI or ARB, a thiazide or thiazide-like diuretic, and a long-acting dihydropyridine CCB is recommended. | Strong | Moderate |
| If BP remains above target despite 3-drug combination therapy consisting of an ACEI or ARB; a thiazide or thiazide-like diuretic; and a long-acting dihydropyridine CCB at their maximally tolerated doses, the addition of spironolactone is suggested. | Conditional | Moderate |
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Note: ACEI = angiotensin-converting enzyme inhibitor, ARB = angiotensin II receptor blocker, BP = blood pressure, CCB = calcium channel blocker.