A 52-year-old man attending a Health and Wellness Centre during opportunistic screening is found to have blood pressure of 156/96 mmHg. He is asymptomatic. His blood pressure measured again on a separate visit three days later is 154/94 mmHg. According to the national NCD programme protocol, the most appropriate next step is:

• A Reassure and recheck after one year since he is asymptomatic
• B Initiate lifestyle advice alone and review after six months without drugs
• C Refer immediately to a tertiary care centre for 24-hour ambulatory monitoring before any treatment
• D Diagnose hypertension and initiate antihypertensive therapy along with lifestyle modification ✓

Explanation

Hypertension is diagnosed when systolic BP is 140 mmHg or more and/or diastolic BP is 90 mmHg or more on measurement on two separate occasions. This patient qualifies on both visits. The national protocol empowers the CHO at the Health and Wellness Centre to confirm the diagnosis and start treatment, typically amlodipine 5 mg, together with lifestyle advice. Routine ambulatory monitoring or tertiary referral is not required for uncomplicated newly diagnosed hypertension.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.