Patient Care and Monitoring

1. Measure patient BP twice, at least 1 minute apart in a sitting position, and then average the readings to determine if BP is adequately controlled.

2. Conduct a medical history. Does the patient have any compelling indications? Is the patient pregnant?

3. Conduct a medication history (prescription, over-the-counter, and dietary supplements) to determine conditions or causes of hypertension. Does the patient take any medications, supplements, herbal products, or foods that may elevate SBP or DBP? Does the patient have drug allergies?

4. Review available laboratory tests to examine electrolyte balance and renal function.

5. Discuss lifestyle modifications that may reduce BP with the patient. Determine what nonpharmacologic approaches might be or have been helpful to the patient.

6. Evaluate the patient if pharmacologic treatment has reached the target BP goal. If the patient is at the goal, skip to step 9.

7. If patient is not at goal BP, assess efficacy, safety, and compliance of the antihypertensive regimen to determine if a dose increase or additional antihypertensive agent (step 8) is needed to achieve goal BP.

8. Select an agent to minimize adverse drug reactions and interactions when additional drug therapy is needed. Does the patient have prescription coverage or is the recommended agent in the formulary?

9. Open a dialogue to address patient concerns about hypertension and management of the condition.

10. Provide a plan to assess effectiveness and safety of therapy. Follow-up at monthly intervals or less until BP is achieved, otherwise semiannual or annual clinic visits to assess electrolyte balance and renal function once BP target is achieved. Presence of comorbidities (i.e., CKD) may require more frequent follow-up.

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