Blood Pressure Measurement
Average of ≥2 readings on ≥2 occasions
All Pathways
Internal MedicineManagement
Hypertension Management (ACC/AHA 2017)
Hypertension Management (ACC/AHA 2017): Blood Pressure Measurement → BP Classification → Normal BP (<120/80).
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Decision BP Classification
Classify based on systolic/diastolic readings
- Normal: <120/<80 mmHg
- Elevated: 120-129/<80 mmHg
- Stage 1 HTN: 130-139 or 80-89 mmHg
- Stage 2 HTN: ≥140 or ≥90 mmHg
03Outcome Normal BP (<120/80)
Promote healthy lifestyle, reassess annually
04Action Elevated BP (120-129/<80)
Nonpharmacologic therapy
- Weight loss if overweight
- DASH diet
- Sodium reduction <1500mg/day
- Physical activity 90-150 min/week
- Limit alcohol
05Action ASCVD Risk <10%
Lifestyle modification, reassess in 3-6 months
- Nonpharmacologic therapy alone initially
- If BP still elevated at 3-6 months, add medication
- Consider medication if compelling indication
06Action First-Line Antihypertensive Agents
Choose based on compelling indications
- Thiazide diuretics (chlorthalidone preferred)
- ACE inhibitors (if DM, CKD, HF, post-MI)
- ARBs (alternative to ACE-I)
- Calcium channel blockers (DHP preferred)
- Avoid: ACE-I + ARB combination
07Action Compelling Indications
Specific drug classes recommended
- CKD: ACE-I or ARB
- Diabetes: ACE-I or ARB
- Heart Failure: ACE-I/ARB + BB + diuretic
- Post-MI: BB + ACE-I
- Recurrent stroke: Thiazide + ACE-I
- Stable CAD: BB, CCB, ACE-I
08Action Monthly Follow-Up
Titrate until goal achieved
- Goal: <130/80 for most patients
- Increase dose or add agent monthly if not at goal
- If 3 agents needed, add spironolactone
- Consider specialist referral if resistant
09Outcome BP Goal Achieved (<130/80)
Continue therapy, follow-up every 3-6 months
10Warning Resistant Hypertension
BP above goal on ≥3 agents including diuretic
- Confirm true resistance (adherence, technique)
- Screen for secondary causes
- Consider specialist referral
- Add spironolactone 25-50mg
- Path rejoins step 08Shared downstream outcome
11Decision Stage 1 HTN (130-139/80-89)
Assess 10-year ASCVD risk
- Use ACC/AHA ASCVD Risk Calculator
- Consider clinical ASCVD, DM, CKD
- Risk ≥10% = high risk
- Path rejoins step 05Shared downstream outcome
12Action ASCVD Risk ≥10% or Clinical CVD/DM/CKD
Lifestyle + pharmacotherapy
- Start single first-line agent
- Titrate to goal <130/80
- Follow up in 1 month
- Path rejoins step 06Shared downstream outcome
13Action Stage 2 HTN (≥140/90)
Initiate pharmacotherapy + lifestyle
- Start with 2 first-line agents
- Consider single-pill combination
- BP goal <130/80 for most patients
- Path rejoins step 06Shared downstream outcome
Guideline Source
2017 ACC/AHA Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address pediatric hypertension
- Does not cover hypertensive emergency (see separate algorithm)
- Drug dosing not included - refer to institutional protocols
- Secondary hypertension workup requires specialist evaluation
- Pregnancy-related hypertension requires OB consultation
Contraindicated Populations
pediatricpregnancy
Applicable Regions
USEU
EU: ESC/ESH 2018 uses slightly different thresholds
US: Based on ACC/AHA 2017 guidelines with BP threshold 130/80
Version 1Next review: 2028-01-01
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Related Resources
Frequently Asked Questions
What is the Hypertension Management (ACC/AHA 2017)?
The Hypertension Management (ACC/AHA 2017) is a management clinical algorithm for Internal Medicine. It provides a structured decision tree to guide clinical decision-making, based on 2017 ACC/AHA Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.
What guideline is the Hypertension Management (ACC/AHA 2017) based on?
This algorithm is based on 2017 ACC/AHA Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (DOI: 10.1161/HYP.0000000000000065).
What are the limitations of the Hypertension Management (ACC/AHA 2017)?
Known limitations include: Does not address pediatric hypertension; Does not cover hypertensive emergency (see separate algorithm); Drug dosing not included - refer to institutional protocols; Secondary hypertension workup requires specialist evaluation; Pregnancy-related hypertension requires OB consultation. Individual patient factors may require deviation from these recommendations.
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