Thoughts on therapeutic choices
When treating with anti-hypertensive agents several principles can help guide therapeutic choices;
Out of Office BP Monitoring
The most important component to the evaluation and treatment of hypertension is the accurate measurement of BP. Evaluation of BP in the office is limited by; small number of measurements, poor technique, the white coat effect (increase in BP in the medical environment) and the masked effect (a decrease in BP that happened in the medical environment). For these reasons there is considerable increased focus on out of office BP measurements. This includes the utilization of either home self-BP measurement or ambulatory blood pressure measurement (ABPM).
Which anti-hypertensive agent?
Patents at low cardiovascular risk and stage 1 hypertension can be initially treated with lifestyle modification solely. Those with manifestations of target organ damage and sustained BP >140/90 should have initiation of pharmacologic therapy after diagnosis of hypertension is confirmed.