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Blood Pressure (BP) targets

  • essential hypertension: BP less than 140/90 mmHg
  • if chronic kidney disease (CKD): BP less than 140/90 mmHg  
  • if CKD and albuminuria (urine albumin:creatinine ratio greater than 30mg/mmol): BP less than 130/80 mmHg
  • if diabetes: BP less than 140/80 mmHg  
  • if diabetes and eye, cardiovascular or kidney damage including microalbuminuria (2 of 3 morning samples: ACR >2·5mg/mmol for males and >3·5mg/mmol for females) BP less than 130/80 mmHg.Indapamide

Try to avoid systolic blood pressure below 120 mmHg: www.nice.org.uk and www.renal.org.

If BP is not controlled at each step progress to next step.

Advise all patients on lifestyle measures, eg smoking, physical activity, weight, alcohol, diet (including salt intake).




*ACE inhibitor:

  • lisinopril (start at 5mg daily, usual maintenance 20mg) or perindopril erbumine if first dose hypotension an issue (start at 2 to 4mg daily).
  • if intolerant of ACE inhibitor consider angiotensin-II receptor antagonist.
  • issue ‘Sick Day Rule’ card.
  • check U&Es 1 to 2 weeks after starting/dose increase. Monitor annually if stable.
  • avoid the combination of ACE inhibitor and angiotensin-II receptor antagonist.
  • use caution when combining ACE inhibitors or angiotensin-II receptor antagonists with spironolactone due to risk of hyperkalaemia.

Beta-blocker therapy: may be indicated as first-line therapy in ischaemic heart disease. 

Primary prevention: if diabetes or 10 year risk of CVD is 20% or more, or a strong family history of premature vascular disease, recommend lipid-regulating therapies; see guidance and the ASSIGN score at http://assign-score.com.

Antiplatelet drugs (aspirin and clopidogrel): use in secondary prevention only (ensure continued if vascular disease is present).

Abbreviation Meaning
BP Blood Pressure
ACE inhibitor Angiotensin-converting-enzyme inhibitors
U+Es Urea and electrolytes
ACR Urine albumin to creatinine ratio 
Editorial Information

Last reviewed: 31 May 2016

Next review: 31 May 2018

Author(s): Formulary Subgroup

Approved By: TAM subgroup of ADTC

Reviewer Name(s): Peter Clarkson, Duncan Scott, Stewart Lambie

Document Id: TAM134