Detecting and managing high blood pressure

Clinical description

• 1 out of 4 adults in Malawi have hypertension and over 75% of these have not been diagnosed.
• Even without hypertension, HIV patients have a higher risk of stroke.
• Managing all hypertensive ART patients can prevent many cases of stroke, heart and kidney

failure and other complications.

• Screen all adults for hypertension:

o Record BP on patient card header.

o Check BP at least once a year for patients 30 years +.

Correct BP measurement method

• Make sure the patient is relaxed (rest at least 10 minutes after physical activity).
• Sit upright, remove clothing from upper arm that may restrict blood flow or interfere with BP cuff.
• Make sure BP cuff is the right size: check the arm circumference is within range shown on the cuff.
• If the initial reading is higher than 140 systolic and/or 90 diastolic:

o Repeat reading twice. Wait for at least 5 minutes between readings.

o Record the lowest reading Classification Systolic Diastolic Management Mild 140-159 and/or 90-99 Try lifestyle measures alone, start stepped treatment if no normalization after 6 months Moderate 160-179 and/or 100-109 Lifestyle measures + stepped treatment Severe >180 and/or >110 Urgent treatment Lifestyle measures + stepped treatment Management of hypertension

• Start management for hypertension if the lowest reading is higher than 140 systolic and/or

diastolic.

• Urgent treatment for severe hypertension if the repeat reading is 180 systolic and/or 110 diastolic.
• Screen for diabetes and symptoms and signs of end organ damage (eye, heart, kidney).
• Lifestyle measures: Eat more vegetables and fruits, less meat / fat, reduce salt, stop smoking,

exercise regularly, normalize weight, limit or stop alcohol

• See latest Malawi Standard Treatment Guidelines for stepped anti-hypertension treatment.

Management of non-communicable diseases