2 VIEWS & REVIEWS Managing essential hypertension · . m pnmary care

Inconsistencies have evolved in recommendations made by various bodies concerning thresholds for intervention, and the goals of treatment, in patients with essential hypertension, despite reference to a common database, says Professor Peter Sever from St Mary's Hospital, London, UK.

Professor Sever proposes that the key issue in the management of essential hypertension in primary care is targeting patients who will benefit from treatment, and also to ensure that drug therapy modifications and! or dosage changes occur in patients who fail prior therapy.

Four simple rules In a review of the management of essential hyper­

tension in the context of primary care, Professor Sever recommends the following 4 simple rules: • rely on systolic BP values for decisions on treatment

thresholds and goals, rather than diastolic BP measure­ments

• assess cardiovascular risk by history taking, physical examination and simple investigation (e.g. EeG, estimation of lipid profile, smoking status and presence or absence of diabetes mellitus)

• apply the threshold 150mm Hg systolic BP rule (this may be reduced to l40mm Hg for higher-risk patients, or raised to 160mm Hg for low-risk patients and the elderly)

• increase dosage of medication (except diuretics), switch or add-on therapy if initial drug is ineffective, partially effective or poorly tolerated.

Sever PS. Simple blood p-essurc guidelines fur pimary health care. Journal of Human Hypertcnsion 13: 72S-727,Nov 1999 _

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