Management of Uncontrolled Hypertension

Current Status Assessment

The American Heart Association recommends a target blood pressure of <130/80 mmHg for patients in this age group, which is exceeded by the patient's office BP readings of 130/90 mmHg and 132/88 mmHg 1
Home blood pressure readings of approximately 140/90 mmHg also exceed the target blood pressure 1
The International Society of Hypertension guidelines recommend a target blood pressure of <130/80 mmHg for this age group, which is not being met 2, 3

The International Society of Hypertension guidelines recommend increasing ACE inhibitor dose to full dose before adding additional agents in non-black patients 1, 4
For patients aged 50-80 years with persistent blood pressure elevation, prompt medication adjustment is indicated rather than extended periods of lifestyle modification alone 5
The patient's current blood pressure readings indicate Grade 1 Hypertension, which requires medication adjustment 6

Increasing lisinopril from 5 mg to 10 mg daily is recommended, as this follows the guideline recommendation to increase to full dose of ACE inhibitor before adding additional agents 2, 7
Monitoring blood pressure response over the next 4 weeks is recommended 8
If blood pressure remains uncontrolled after 4 weeks on increased dose, consider further increasing lisinopril up to 20 mg daily 9, 10
Adding a thiazide/thiazide-like diuretic as the next step is recommended if blood pressure remains uncontrolled on maximum tolerated lisinopril dose 9

The target blood pressure for this 70-year-old patient should be <130/80 mmHg, but individualize based on frailty status 3
Monitoring for potential adverse effects more closely in elderly patients is recommended, including postural hypotension, changes in renal function, and electrolyte disturbances

Rechecking blood pressure within 4 weeks of dose adjustment is recommended 8
Assessing for side effects such as dizziness, cough, and changes in renal function is recommended
Aiming to achieve target blood pressure within 3 months of treatment initiation is recommended 3
Considering home blood pressure monitoring to guide therapy, with target home blood pressure <135/85 mmHg, is recommended 1