Hypertension

Use the American Heart Association (AHA) Home Blood Pressure Monitoring instructions to teach patients proper technique. Cuffless wearables should not determine diagnosis or medication titration.

• Use HBPM or ABPM to confirm sustained elevation and identify white-coat or masked patterns; ABPM also evaluates nighttime BP.
• Discordant readings: Recheck cuff fit, technique, timing, and recording adequacy. Measure orthostatic BP when symptoms or clinical risk warrant it.

• Baseline evaluation: Review cardiovascular disease (CVD), stroke, diabetes, CKD, pregnancy potential, and all medications. Obtain renal function, electrolytes, metabolic testing, urinalysis, urine albumin-to-creatinine ratio (UACR), and electrocardiogram (ECG).
• Predicting Risk of Cardiovascular Disease Events (PREVENT): For eligible adults without established CVD, use the PREVENT calculator’s 10-year total CVD estimate for stage 1 treatment decisions. Note that PREVENT atherosclerotic cardiovascular disease (PREVENT-ASCVD) is the estimate used for lipid decisions.
• Secondary causes: Evaluate clinical clues to primary aldosteronism, obstructive sleep apnea (OSA), renal disease, and other endocrine causes. Review use of nonsteroidal anti-inflammatory drugs (NSAIDs), stimulants, decongestants, glucocorticoids, and hormonal agents.
• Primary aldosteronism: Screen resistant HTN even without hypokalemia. Interpret aldosterone, renin, and the adosterone-to-renin ratio (ARR) in the context of potassium and interfering medications.Treatment