Hypertension Management in Adults

Initial Assessment and Adjustment

The American Heart Association recommends confirming inadequate BP control with multiple readings (at least 2 readings) 1
Target BP should be <130/80 mmHg according to current guidelines from the American College of Cardiology 4
Verify proper measurement technique using validated device with appropriate cuff size, as recommended by the American Heart Association 3
For a patient on metoprolol and amlodipine, the most effective adjustment strategy is to add a thiazide-like diuretic while maintaining the current medications, as recommended by the European Society of Cardiology 1, 2

Add a thiazide-like diuretic (e.g., chlorthalidone or indapamide) as the first option, following the recommended step-wise approach for non-black patients after CCB and beta-blocker therapy, as suggested by the American College of Cardiology 1, 7
Consider adding spironolactone 25 mg if BP remains uncontrolled after adding a thiazide diuretic, particularly for resistant hypertension, as recommended by the European Society of Cardiology 7, 8

Recheck BP within 4 weeks of medication adjustment, as recommended by the American Heart Association 4
Target BP control should be achieved within 3 months, according to the American College of Cardiology 6
Monitor for potential side effects, including electrolyte disturbances if a diuretic is added, as suggested by the European Society of Cardiology 7
If BP remains uncontrolled after implementing adjustments, refer to a hypertension specialist, as recommended by the American Society of Hypertension 8