Does Bill need BP-lowering medicine?
Before deciding whether or not to prescribe BP-lowering medicine, you need to confirm that Bill has hypertension. To do this, Bill s BP should be measured on a subsequent visit, preferably by the practice nurse to minimise the white coat effect.
If hypertension is confirmed from multiple BP measurements, Bill s medical history should be recorded and he should be examined for, and investigations done to see if he has, cardiovascular disease (CVD) or target organ damage.
In the absence of CVD or target organ damage, you should formally calculate Bill s absolute risk score.
Regardless of whether Bill s absolute risk is low, medium or high, you should recommend behavioural modification as the basis of his hypertension management (e.g. reduced alcohol intake) and to reduce his risk of CVD (smoking cessation). However, if Bill s BP is still
> 140/90 mmHg, refer to the hypertension management algorithm (Figure 1 of Hypertension treatment poster).