Elementor #809 – Fardows Salim Web

Blood Pressure Readings

Average of ≥2 properly measured readings on ≥2 occasions

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📏 Proper Measurement Technique

Patient seated quietly for ≥5 min, feet flat, back supported. Arm at heart level. Validated electronic device. Average of 2 readings taken 1–2 minutes apart. Confirm with out-of-office readings (home BP or 24-hour ABPM) before initiating therapy.

AAverage BP Reading

Systolic BP mmHg *

SBP

Diastolic BP mmHg *

DBP

BOut-of-Office BP If available — helps confirm white coat vs. masked HTN

Home BP Average SBP/DBP

Home DBP mmHg

CPatient Demographics

Age years *

Sex *

Race/Ethnicity

Weight lbs

DAuto-Staged BP Category Set from readings — override if needed

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Normal

<120/<80

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Elevated

120–129/<80

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Stage 1

130–139/80–89

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Stage 2

≥140/≥90

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Crisis

≥180/≥120

Comorbidities & Compelling Indications

Drive first-line drug class selection — critical for individualized therapy

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💡 Why Compelling Indications Matter

2025 AHA/ACC and JNC 8: Certain comorbidities mandate specific drug classes regardless of BP stage — these are "compelling indications." For example, post-MI patients require beta-blockers + ACEi/ARB, CKD patients require ACEi/ARB to slow progression, and heart failure patients require specific combinations. These override standard monotherapy selection.

Diabetes (Type 1 or 2)?

CKD Stage

Heart Failure?

Coronary Artery Disease?

Prior Stroke / TIA?

Atrial Fibrillation?

Aortic Aneurysm?

Pregnancy / Planning?

Proteinuria / Albuminuria?

BLifestyle & Risk Factors

Current Smoker?

ASCVD Risk (10-yr)

Alcohol Use

Laboratory Values

Guides drug selection, contraindications, and goal adjustment

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eGFR mL/min/1.73m²

Serum K⁺ mEq/L

Serum Cr mg/dL

Sodium mEq/L

Urine ACR mg/g

Fasting Glucose mg/dL

HbA1c %

TSH mIU/L

Secondary Hypertension Screening

Consider if young, resistant, or unusual features present

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🔍 When to Suspect Secondary HTN

Age <30 with no family history, resistant HTN on ≥3 agents, hypokalemia (especially on ACEi/ARB), onset after age 55 (renal artery stenosis), cushingoid features, or episodic HTN with diaphoresis (pheochromocytoma).

Resistant HTN?

OSA Diagnosed / Suspected?

BSecondary Cause Clues

Renal artery stenosis suspectedBruit, young F, flash pulmonary edema, Cr rise on ACEi

Pheochromocytoma suspectedEpisodic HTN, headache, sweating, palpitations

Primary Aldosteronism suspectedHypokalemia, adrenal incidentaloma, resistant HTN

Thyroid disease suspectedHypothyroidism (diastolic HTN) / Hyperthyroidism (systolic HTN)

Cushing syndrome suspectedCentral obesity, striae, moon facies, buffalo hump

Coarctation of aorta suspectedYoung patient, radio-femoral delay, rib notching

Lifestyle Counseling & Note Options

Document counseling provided today

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ACounseling Provided Today

DASH diet counselingHigh fruits/vegetables, low sodium, low saturated fat

Sodium restriction counselingGoal <2.3 g/day — can reduce SBP 4–8 mmHg

Exercise prescription≥150 min/week moderate aerobic — reduces SBP 4–9 mmHg

Weight loss counseling~1 mmHg SBP per 1 kg lost

Alcohol reduction counselingLimit ≤2 drinks/day M, ≤1 drink/day F

Smoking cessation counselingSmoking dramatically increases CVD risk

Stress reduction / sleepMindfulness, sleep hygiene, relaxation techniques

Additional Notes Clinician free-text

Live Decision Support

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Enter the systolic and diastolic blood pressure above to generate evidence-based staging and treatment recommendations.

Comorbidities, labs, and current medications refine recommendations automatically.

Salim, MD

Salim, MD

Hypertension Management Decision Support Calculator