Follow-up of medication therapy

a) Follow-up should include:

1. Necessary blood work (serum potassium and creatinine, every 6-12 months)

2. Blood pressure measure and weight

3. Enquiry regarding general health status, side effects and any treatment

4. Reinforce or advise on non-pharmacological measure to control blood pressure

5. Annual urine test for proteinuria

b) With   Stage   2 (consistent with   Grade 2  of  the   WHO/ISH  classifications)  or  complicated hypertension, clients require more frequent follow-up

➪ Practice Point:

Factors to consider when target blood pressure is not being reached:

• Difficulty following treatment regimen (e.g., complexity, socioeconomic barriers, psychological factors).
• Lifestyle (e.g., inability to lose weight, excessive alcohol intake).
• Treatment prescribed may be ineffective.
• Isolated clinic (white-coat) hypertension.
• Use of inappropriate cuff size.
• Use of drugs that raise blood pressure (e.g., NSAIDs, sympathomimetics, herbal remedies)
• Volume overload (e.g., high sodium intake, renal insufficiency, inadequate or ineffective diuretic therapy)
• Unsuspected secondary cause (e.g., renal or endocrine disorders, sleep apnea).