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Paucis Verbis: First-Line Treatment for Hypertension

Posted Feb 11 2011 12:00am

A 50 year-old woman, who presented to the ENT clinic for followup check of a facial fracture, has a blood pressure of 210/100. She is asymptomatic and in no pain. She gets referred immediately to the ED for care.

Now you see her in your ED. What next? 

There is a lot of controversy whether you should treat or not treat asymptomatic hypertension in the ED. The ACEP Clinical Policy says that there is no need to immediately reduce an asymptomatic patient's blood pressure. With "close followup", they can be referred to their primary care physician. 

With so many patients being uninsured or unable to access their primary care physician on short notice, many emergency physicians like myself are slowly moving towards starting antihypertensive medications for them.

If you do decide to start an antihypertensive, which medication do you choose? This Paucis Verbis card is based on a 2009  Cochrane Review , and summarized in American Family Physician in 2010. The blue numbers denote a Risk Ratio (RR) which cross 1, meaning that there is no benefit. The red numbers denote a RR < 1, meaning that there IS a benefit.

Bottom line: 
A low-dose thiazide, such as hydrochlorothiazide 12.5-25 mg po daily, is a safe and effective choice.

Feel free to download this card and print on a 4'' x 6'' index card.

[ MS Word ] [ PDF ] See  other Paucis Verbis cards .
Quynh B. Cochrane for clinicians. First-line treatment for hypertension. Amer Fam Phys. 2010, 81(11), 1333-5.
Mensah G, Bakris G. Treatment and Control of High Blood Pressure in Adults. Cardiology Clinics. 2010, 28(4), 609-22. 

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