Measure it properly
- Seated, back supported, legs uncrossed, bladder empty.
- Rest 5 minutes; no talking.
- Arm over 32 cm: large cuff.
- Two readings a few minutes apart; record the second.
- Validated automated device where there is power.
Observer checklist (skills station)
- Arm measured and right cuff chosen
- Rested 5 minutes, silent
- Arm supported
- Two readings; second recorded
- Result explained to the patient
Diagnose
| First reading | Next step |
|---|
| 160/100 or more | Start treatment today |
| 140 to 159 or 90 to 99 | Recheck another day (1 to 4 weeks) |
| Below 140/90 | Advice; recheck later |
Treat by protocol
- First line: thiazide-type diuretic, ACE inhibitor or ARB, long-acting calcium channel blocker.
- Start two, ideally one pill. Step up monthly.
- Never delay treatment for tests.
- Could be pregnant, no contraception: amlodipine only.
Targets and follow-up
- Below 140/90 for most people.
- Systolic below 130 with heart disease or stroke.
- Monthly until controlled, then every 3 to 6 months.
Total cardiovascular risk
- Use the WHO chart for your region.
- 20% or more: statin, treat BP from 130/80, see every 3 months.
- Past heart attack or stroke: high risk without a chart.
- Aspirin only after heart attack or ischaemic stroke.
Refer the same day
BP 180/110 or more with headache, breathlessness, blurred vision, confusion, vomiting or little urine; signs of stroke or heart attack.
Say it simply
High blood pressure has no symptoms, but it damages the heart, brain and kidneys. Take your tablets every day, even when you feel well, and come back before they run out.
Less than 5 g of salt a day. No tobacco. About 150 minutes of brisk walking a week.
Sources
World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. 2021. World Health Organization. HEARTS technical package: evidence-based treatment protocols. 2018. World Health Organization. HEARTS technical package: risk-based CVD management. 2020. World Health Organization. Diagnosis and management of type 2 diabetes (HEARTS-D). 2020.