Over 50 million Americans have hypertension, it is the most commonly used diagnosis in Family Practice. Multiple studies have shown a strong, continuous, graded increase in cardiovascular events with increased blood pressure and that the association for Systolic BP is stronger than for Diastolic BP. MCI emphasizes the use of thiazide diuretics which JNC-7 finds are “unsurpassed in preventing the cardiovascular complications of hypertension”. According to national data (NHANES 1999-2000) only 34% of patients diagnosed with hypertension are controlled. The MCI goal is 70% controlled. To achieve this Mercy Clinics, Inc. endorses the following recommendations:

1. Blood pressure should be measured in a standardized fashion:
   • Patients should be seated with arms bared and appropriate size cuff used.
   • Systolic Blood Pressure is defined as the first appearance of sound.
   • Diastolic Blood Pressure is defined as the disappearance of sound.
   • Any elevated Blood Pressure should be followed up.
   • Diagnose Hypertension if the BP is > 139/89 on three separate occasions.
     • If BP is elevated the provider should re-check and document the result.
2. Set a clear goal of therapy for each patient.  Control blood pressure to:
   • Below 140/90 for uncomplicated hypertension.
   • set lower goals for patients with target organ damage or cardiovascular disease.
   • Below 130/80 for patients with diabetes or chronic kidney disease.
   • Medication compliance should be explored for patients not meeting their goal.
3.  Life style modifications should be encouraged in all patients.
   • Quit smoking, lose weight (if needed), restrict sodium intake, limit alcohol, DASH diet, aerobic exercise.
4. Add pharmacologic therapy if blood pressure remains above goal with life style modifications.
   • Thiazide diuretics (alone or in combination) are recommended as initial therapy for most patients. 
   • Most patients will require 2 or more medications to control BP.
   • Favor once daily, generic medicines when possible.
5. Evaluate for co-existing risk factors which are found in 80% of patients with hypertension.
   • Diabetes, lipids, obesity, LVH, microalbuminuria, smoking
6.  People with systolic BP of 120-139 or a diastolic BP of 80-89 have Pre-Hypertension.  There is a high probability that they will develop hypertension and they should be treated with lifestyle modification to prevent CVD.

Reference: 

The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. NIH publication May 2003.

Variation from this guideline is always acceptable if in the opinion of the attending physician individual circumstances require it