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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017
266
AFRICA
SCREENING
In health centre, clinic, hospital, pharmacy,
markets and churches
CLINIC/HOSPITAL
By physicians and nurses. If
≥
180/110 mmHg, refer.
If
<
140/90 mmHg, recheck after 6 months
Systolic BP of 140–159 or diastolic BP 90–99 mmHg
without target-organ damage* and no diabetes
Systolic BP
≥
160 or diastolic BP
≥
100 mmHg
Systolic BP 140–159 or diastolic BP 90–99 mmHg
AND diabetes/target-organ damage*
Encourage patient to carry out self-monitoring and
adherence to medications
Advise the patient to inform the physician or
health centre if he or she notices BP elevation
or side effects
Patients should be advised to continue office visits
6 monthly as clinically appropriate
Lifestyle modification** as a trial for 3–6 months.
If this fails, consider adding a thiazide or thiazide-
like diuretic or long-acting CCB as monotherapy
Combination of two medications preferred:
thiazide or thiazide-like diuretic plus ACEI or ARB
or CCB, or CCB plus ACEI or ARB”
AND lifestyle modifications
Recheck and review readings in 3 months
ACEI: angiotensin converting enzyme inhibitors, ARB: angiotensin receptor blocker, CCB: calcium channel blocker
*Target-organ damage indicates people with evidence of hypertensive heart disease, stroke or renal disease. In these people and those with
diabetes, ACEI or ARBs should be preferred.
**Lifestyle modifications include a reduction in weight, a diet rich in fruits, vegetables and low fats, a moderation of alcohol consumption and
smoking cessation, a lower sodium intake and a regular aerobic physical activity (at least 30 min per day for at least 5 days per week).
We emphasise that this algorithm does not replace the treating healthcare provider’s best clinical judgement.
Recheck and review readings in 4 weeks
BP at goal (
<
140/90 mmHg)?
Recheck and review readings in 4 weeks
NO
NO
YES
YES
If currently on BP medications optimise therapy or
add drug from different classes.
If not on BP medications, commence thiazide or
thizide-like diuretic
Consider referal to specialist if:
• Patient with 3 medications (including a thiazide or
thiazide-like diuretic) and BP not at goal
• Secondary causes suspected
• Heart disease, kidney disease, or stroke
• BP
>
180/110 mmHg
Optimise current dosages or add medications
from a different class. Also consider adding
spironolactone or a vasodilating beta-blocker or a
long-acting
α
-blocker
Address adherence, advise on self-monitoring and
request readings rom home and other settings.
BP at goal (
<
140/90 mmHg)?
Fig 2.
PASCAR hypertension treatment algorithm