The U.S. hypertension guideline updates screening, treatment thresholds, and condition-specific management.1 Screening for primary aldosteronism is now recommended for all cases of resistant hypertension, and most antihypertensives (except MRAs) should be continued during testing.
Potassium-based salt substitutes may help lower BP except in CKD or impaired potassium excretion. Medication with treatment recommended at ≥130/80 mm Hg for higher-risk groups and after lifestyle trials for lower-risk groups. ACEi/ARB use is strengthened for diabetes and CKD with albuminuria (Candesartan is recommended in NZ).
Pregnancy recommendations emphasise rapid treatment of severe hypertension, treating chronic hypertension to <140/90, giving low-dose aspirin, and avoiding ACEi/ARB, atenolol, MRAs, and renin inhibitors.
Resistant hypertension management includes multidisciplinary evaluation and careful medication review.
Check for secondary causes in under-40-year-olds' renal artery stenosis, pheochromocytoma, primary aldosteronism and Cushing's pheochromocytoma or paraganglioma, drugs, e.g. methamphetamine and alcohol.
