Hypertension Management — Adults

Diagnosis · risk-based treatment · targets · review

Field: CardiovascularCode: CV-01Updated: June 2026Reference: NHFA / Aus CVD risk guideline

Confirm the diagnosis out of clinic before treating. Use home or ambulatory BP monitoring (or automated office BP) in preference to a single clinic reading — this avoids over- and under-treating white-coat and masked hypertension. Base the decision to treat on BP level and absolute CVD risk together, not BP alone.

Stepped treatment — preferred: dual therapy from the outset

Two-class combination, often a single pill, for most starting treatment.

ACE inhibitor/ARB + CCB or thiazide-like diuretic, low-dose.

Triple therapy: add the third class if not at target after 4–6 weeks.

Resistant: add spironolactone once adherence & causes checked.

Refer if still above target on optimal triple therapy.

Alternative — monotherapy start

Reasonable where BP is close to target, or in frailty/older age.

Single agent: ACE inhibitor, ARB, CCB or diuretic.

Add a second class if not at target after 4–6 weeks.

Move to triple therapy if still above target.

Refer if resistant on three classes incl. a diuretic.

Exact doses & combinations — For exact strengths, single-pill combinations and PBS first-line eligibility, use the current Therapeutic Guidelines (eTG) hypertension topic and check pbs.gov.au.

Confirm the diagnosis — out of clinic

Office ≥140/90 (≥2 visits); home ≥135/85; ambulatory ≥130/80. Prefer home/ambulatory or automated office BP over a single clinic reading.

Who to treat & target BP

High risk (≥10%, cvdcheck.org.au) or BP ≥160/100, diabetes, CKD, CVD → treat. Intermediate → consider. Low → lifestyle first. Target <140/90; <130/80 if tolerated.

Lifestyle — offer to every patient

Salt reduction or substitution, and a DASH-style eating pattern.
Regular physical activity, alcohol moderation and smoking cessation.
Structured behavioural support works better than verbal advice alone.

Secondary causes at diagnosis

Screen for primary aldosteronism in early-onset, resistant, or hypokalaemic hypertension — normal potassium does not exclude it (present in only ~30%).

Monitoring & review

Recheck BP 4–6 weeks after any change, then 6–12 monthly at target. Reassess CVD risk 2-yearly (intermediate) or 5-yearly (low). Annual: adherence, technique, renal function.

Safety

BP ≥180/110 with symptoms → same-day assessment.
Check renal function & potassium before & after starting an ACEi/ARB or diuretic.
Creatinine >30% rise on ACEi/ARB → stop & investigate.
Avoid ACEi, ARBs & renin inhibitors in or planning pregnancy.

Red flags / refer

Resistant: above target on 3 classes incl. a diuretic, adherence confirmed.
Age <30 years at diagnosis, or signs of a secondary cause.
Suspected primary aldosteronism: early-onset, resistant or hypokalaemic.
Hypertensive emergency: severe BP with end-organ symptoms — same-day or ED.

CV-01 v1.0 · Reviewed Jun 2026 · Review Sep 2026

For health-professional use. Framework: 2016 NHFA hypertension guideline & 2023 Aus CVD risk guideline. New national hypertension guideline due Q3 2026 — recheck thresholds then. Doses: pbs.gov.au / eTG.