Common dilemmas in managing hypertension

Abstract

Background: Undertaking a blood pressure measurement is a common occurrence in general practice. Excellent guidelines for the management of hypertension are available to all Australian general practitioners. There are, however, variants of primary hypertension that present management dilemmas, such as: is it ever safe to stop medication, the role of ambulatory blood pressure monitoring, and refractory or isolated systolic hypertension.

Objective: To provide management guidance on some of the difficult dilemmas that may occur in relation to blood pressure control in everyday practice while recognising the limitations of the application of scientific evidence to the individual presenting patient.

Discussion: Recommendations are given for the withdrawal of antihypertensive medication in a select group of patients. Ambulatory blood pressure monitoring is recommended for the patient with labile or refractory hypertension and where 'white coat' hypertension is suspected. Management advice is given for the very old, the asymptomatic middle-aged man, and refractory and isolated systolic hypertension.