2010 Hong Kong Reference Framework for Hypertension Care for ...

Module 7Drug Treatment for People with HypertensionTreatment algorithmDrug treatment for essential HTCompelling indication /contraindication over choiceof drugYesGo to Appendix 1NoStart with either ACEI (or ARB if ACEI intolerant),calcium channel blocker or thiazide-type diuretic●●●●No response or not tolerated, switch to another drugInadequate response but tolerated, add a second drugfrom different classIf blood pressure goal is still not reached, increase doseor consider adding third drug from different classRefer to specialist if blood pressure still not under controlChoices of antihypertensive drugs and goals of therapyThe ultimate goal of anti-hypertensive therapy is to reduce cardiovascularmorbidity and mortality. There are excellent clinical outcome trial data provingthat lowering blood pressure with different classes of anti-hypertensives,including angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptorblockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs), andthiazide-type diuretics, will all reduce the complications of hypertension. 4,6-11,14 Itshould be emphasized that the perceived risk reduction was directly proportionalto blood pressure reduction rather than the drug class used to achieve it, 1 althoughdifferent drug classes were recognized to have unique benefits specific toindividual patient populations .281 HK Reference Framework for Hypertension Care for Adults in Primary Care Settings