Long-term management

Goals include evaluating medication adherence, monitoring treatment and relevant laboratory studies, and adjusting medication.

• Patients on nonpharmacological treatment alone: Follow up after 3–6 months.

  • If blood pressure is uncontrolled: Initiate pharmacological treatment.

• Most patients initiated on pharmacological treatment: Follow up after ∼ 1 month.

  • If blood pressure is uncontrolled: Continue to escalate therapy at one-month intervals.

  • Once blood pressure is controlled: Reassess after 3–6 months and annually thereafter if blood pressure remains stable.

• Serum electrolytes

  • For most patients, check at the one-month follow-up visit.

• Serum creatinine

  • Check within 2–4 weeks in patients with CKD who were started on an ACEI or ARB.

• Adjust medication based on adverse effects

• Adjust medication to reach optimal blood pressure control.

  • Ask about medication adherence. [6]

  • If indicated, adjust medications using one of the following strategies: [2][25][42]

    • Increasing the dose of the initial drug

    • Switching to another drug

    • Adding a second drug (in the form of a single combination pill, if possible)

  • If the treatment goal cannot be reached with two drugs:

    • Add a third drug.

    • Evaluate for secondary hypertension, if indicated.

Therapeutic inertia (failure on the part of the physician to appropriately escalate treatment when indicated) is one possible reason for poor blood pressure control. Be sure to reassess the treatment plan at each visit.