Mount Carmel Health Partners Clinical Guidelines Hypertension | Page 3

Follow-up and Monitoring
A plan of ongoing care and treatment assessment once BP targets are achieved should take place every 6 months or less depending on
classifica on and pa ent comorbidi es. Reinforce the need for lifestyle modifica on as needed.
• Weight reduc on: maintain normal body weight (BMI 18.5-25 kg/m²)
• Nutri on: suggest Dietary Approaches to Stop Hypertension (DASH) ea ng plan with daily intake of 8-10 servings of fruits and vegetables,
2-3 servings of low-fat dairy products, diet low in saturated fat and cholesterol, high potassium intake of 4.7g for those pa ents with no
impaired potassium excre on.
• Dietary sodium: Reduc on to less than 2.3 g sodium per day.
• Exercise: recommend regular aerobic ac vity such as brisk walking (30-35 minutes per day or most days) adapted according to pa ent’s
physical capacity
• Counseling:
• limit alcohol consump on
• limit caffeine consump on
• smoking cessa on and stress impact smoking has on hypertension
• reduce stressors
• Perform an assessment of risk factors for cardiovascular disease every 12 months or more frequently as needed:
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family history of hypertension
family history of premature CVD
dyslipidemia
diabetes mellitus
obesity (BMI >30)
age
microalbuminuria (GMR <60mL/min)
smoking
physical inac vity
other factors: PCOS (polycys c ovarian syndrome), HELLP Syndrome (hemolysis, elevated liver enzymes, low platelet count), preeclampsia
• For the rapidly growing popula on of hypertensive individuals over age 65 years with isolated systolic hypertension (e.g. a diastolic blood
pressure below 90 mm Hg), cau on is needed not to reduce the diastolic blood pressure too aggressively (to below 55 to 60 mm Hg), since
such low diastolic pressures have been associated with an increased risk for cardiovascular event.
• American Geriatrics Society BEERS Criteria recommenda on to avoid alpha1 blockers in the elderly. Alpha1 blockers for rou ne treatment of
hypertension is considered poten ally inappropriate due to high risk for orthosta c hypotension.
Frequency
Monthly visits
Every 3-6 months
More frequent visits
Every 5-12 months
Criteria
Un l blood pressure goal is reached
When blood pressure is at goal and stable
Comorbid condi on and the need for regular labs
Labs--serum potassium and crea nine
Hypertension - 3