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Starting antihypertensive drug treatment involves a tailored approach that considers individual patient factors, such as age, blood pressure readings, and cardiovascular risk. NICE guidelines recommend initiating treatment based on persistent hypertension stages, with a strong emphasis on shared decision-making and patient engagement.
The guidelines also stress the importance of lifestyle advice in conjunction with medication, the use of clinical judgment in the presence of frailty or multimorbidity, and the necessity of evaluating secondary causes in younger adults. This patient-centered approach aims to optimize treatment effectiveness and adherence, ultimately reducing the risk of cardiovascular events.
| Age Group | Stage | Treatment Consideration | Additional Notes |
|---|---|---|---|
| Adults of any age | Stage 2 Hypertension-persistent | Offer drug treatment plus lifestyle advice | Consider clinical judgement for frailty/multimorbidity |
| Under 80 | Stage 1 Hypertension | Discuss drug treatment if there's target organ damage, CVD, renal disease, diabetes, or ≥10% 10-year CVD risk | Use clinical judgement for frailty/multimorbidity |
| All adults | Discuss individual CVD risk, treatment preferences, and lifestyle changes before starting treatment | - | |
| Under 60 | Stage 1 Hypertension | Consider drug treatment if 10-year CVD risk <10% | Lifetime CVD risk may be underestimated |
| Over 80 | Stage 1 Hypertension | Consider treatment if clinic BP >150/90 mmHg in addition to lifestyle advice | Use clinical judgment... |
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