Good Hope, Heartlands, and Solihull Eye Clinics


David Kinshuck

Management of mild hypertesion

BMJ 16

Below is a table. See BP in diabetes


Stepwise mild hypertension

General measures

diet rich in vegetables and fruit and low-fat dairy with reduced fat intake lowers BP ~11 mm Hg
exercise  >30 minute a day lowers BP ~7 mm Hg
reducing salt lowers BP ~4 mm Hg
each unit of alcohol lowers BP ~2.2 mm Hg
losing weight if overweight each 2% body weight lost lowers BP ~1 mm Hg
  • no chronic kidney disease
  • chronic kidney disease
  • Black
  • none-black
  • All races
  • thiazide diuretic or calcium channel blocker
  • alone or in combination
  • thiazide diuretic or calcium channel blocker or ACE1 or ARB
  • alone
  • in combination
  • ACE1 or ARB alone
  • or in combination with thiazide diuretic or calcium channel blocker
  • change to single generic pill if possible
  • do no use ACE! and ARB together
  • thiazide alone: chlorthalidone
  • Thiazides can cause arise in uric acid (causing gout) of blood sugar (diabetes) or low sodium and or potassium, but are generally safe
  • Thiazides cause less osteoporosis than ACE1 or ARBs.
  • blood tests  U & Es are needed from time to time
  • ACE1 or ARBs check U & Es within 1-2 weeks starting and periodically
  • target BP 120/80 if organ damage/high risk
  • diabetes, renal disease <140/90 office BP
  • well patient target 140/90