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HYPERTENSION: DIAGNOSISCheck blood pressure (BP)• Seat patient with arm supported at heart level for 5 minutes.• Use a standard cuff or larger cuff if mid-upper arm circumference is > 33cm.• Record systolic BP (SBP) and diastolic BP (DBP): SBP is the first appearance of sound. DBP is the disappearance of sound.• If raised, recheck until a reading is repeated. Use this reading to determine the patient’s BP.• Do not diagnose hypertension on the basis of one reading alone.< 180/110• If patient has diabetes diagnose hypertension if BP > 140/80 on 2 days 71.• Is there ischaemic heart disease, peripheral vascular disease, stroke, heart failure or kidney disease?No< 140/90 140/90–179/109130/80–179/109< 130/80Yes≥ 180/110Does patient have any of the following: headache,difficult breathing, visual disturbances, chest pain,confusion, leg swelling?NoYes• Review in5 years ifall readingsnormal.• Review in1 year ifany raisedreadings.Check BP on 2 further occasions at least2 days apart.140/90–159/99Assess CVD risk 68.Is CVD risk > 20%?NoPatient is at risk forhypertension.• Manage patient’s CVDrisk 69.• Recheck BP in 3 months.< 140/90 ≥ 140/90Yes160/100–179/109Check BP on 2further occasionsat least 2 daysapart.BP confirmed130/80–179/109Repeat BP atroutine care visits.• Diagnosehypertension.• Start routinehypertensioncare 74.• Start drugtreatment atstep 1 andstep 2 anti–hypertensivetreatment 74.• Review in 2weeks.Patient needs urgent care• Only treat BP if no sign ofstroke: sudden onset ofweakness on 1 or both sides,vision problems, dizziness,difficulty speaking orswallowing.• Give amlodipine 10mg orallystat. If unavailable, giveenalapril 10mg orally stat.• Avoid short-actingnifedipine as it may dropthe BP too quickly, causinga stroke.• If dizzy or faint aftertreatment, check BP: ifmore than 25% drop or< 160/100, lie patient downwith legs raised.• Refer same day to hospital.• Continue CVD riskmanagement 69.• Check BP in 1 year.• Diagnose hypertension. Do not diagnose hypertensionon the basis of one reading alone.• Start routine hypertension care 74.• Refer if patient is < 30 years or pregnant.73