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<h1>Toolkit for Implementing the Chronic Care Model in an Academic Environment</h1>
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<h2>Hypertension Algorithm for Diabetes in Adults Goal BP <130/80</h2>
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<h3>Table of Contents</h3>
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<ul>
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<li><a href="/prevention/curriculum/chroniccaremodel/index.html">Toolkit for Implementing the Chronic Care Model in an Academic Environment</a></li>
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<li><a href="/prevention/curriculum/chroniccaremodel/chronicack.html">Acknowledgments</a></li>
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<li><a href="/prevention/curriculum/chroniccaremodel/chroniccare1.html">1. Engaging Leadership</a></li>
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<li><a href="/prevention/curriculum/chroniccaremodel/chroniccare2.html">2. Harnessing the Academic Culture</a></li> <li><a href="/prevention/curriculum/chroniccaremodel/chroniccare3.html">3. Implementing the Chronic Care Model into Practice</a></li><li>
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<a href="/prevention/curriculum/chroniccaremodel/chroniccare4.html">4. Health Professions Education for Chronic Care</a></li> <li> <a href="/prevention/curriculum/chroniccaremodel/chronicgloss.html">Glossary</a></li> </ul>
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<article role="article" class="contextual-region node node--type-ahrq-publication node--view-mode-full clearfix" about="/professionals/education/curriculum-tools/chroniccaremodel/chronic2a10.html">
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The Planned Visit Notebook includes a step-by-step description for a diabetes planned visit. The Hypertension Algorithm is a flowchart that takes a health professional through the steps for one part of the diabetes planned visit.</p><p><span><img src="/prevention/curriculum/chroniccaremodel/chronic2a10fig.gif" alt="Hypertension Algorithm for Diabetes in Adults Goal BP less than 130/80. For details, see Text Description below." title="Hypertension Algorithm for Diabetes in Adults Goal BP less than 130/80. For details, see Text Description below." border="0" height="591" width="805" /></span>
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</p><p><strong>Text Description:</strong></p><p>The Hypertension Algorithm begins with a text box that reads: </p><table border="1" cellpadding="8" cellspacing="0" summary="layout" width="40%"><tbody><tr><td align="center">Assess Blood Pressure<br />Evaluate meds/Reinforce lifestyle modification</td></tr></tbody></table>Two arrows lead from it. The one to the left is labeled "BP <130/80 mmHg" and points to a box that reads: <table border="1" cellpadding="8" cellspacing="0" summary="layout" width="20%"><tbody><tr><td align="center">Follow-up BP each visit<br />If microalbuminuria or nephropathy present (Table 1)</td></tr></tbody></table>The arrow to the right is labeled "BP >130/80 mmHg" and points to a box that reads: <table border="1" cellpadding="8" cellspacing="0" summary="layout" width="80%"><tbody><tr><td><p><strong>If DM1 ACE inhibitor (ACEi) therapy is first choice<br />If DM2 start ARB agent is first choice</strong><br />If microalbuminuria or nephropathy present (Table 1)<br />If African-American—Consider starting ACE or ARB in combination with diuretic<br />If SBP >145mm Hg and/or DBP >90mmHg consider starting with combination antihypertensive therapy</p><p>___________________________________________________________________________________________</p><p>Reassess therapy in 1 week—titrate to at least &frac12; max dose (on average >3 medications will be needed to achieve blood pressure goals</p></td></tr></tbody></table>Two arrows lead from this box to two boxes below it. The arrow to the left is labeled "BP <130/80 mmHg" and leads to a small box that reads: <table border="1" cellpadding="8" cellspacing="0" summary="layout" width="20%"><tbody><tr><td align="center"><u>Continue Therapy</u><br />BP Check Every Visit</td></tr></tbody></table>The arrow to the right is labeled "BP >130/80 mmHg" and points to a box that reads: <table border="1" cellpadding="8" cellspacing="0" summary="layout" width="80%"><tbody><tr><td><p><strong>Add Diuretic OR Calcium Channel Blocker (CCB) OR Beta Blocker<br />If Diuretic Chosen:</strong> (Preferred if no other compelling indciations)</p><blockquote>Creatinine <1.8mg/dl Creatinine >1.8md/dl<br />Thiazide diuretic* Loop Diuretic<br />(*Max. dose 25md Hydrochlorothiazide or equivalent)</blockquote><p><strong>If Beta Blocker Chosen:</strong> (Strongly recommended if history of MI)<br />—Choose beta blocker without intrinsic sympathomimetic activity</p><p><strong>If CCB Chosen:</strong></p><blockquote><strong>If Diltiazem or Verapamil Chosen:</strong></blockquote><p>Pulse and conduction effects should be considered if combined with B blocker</p><p>___________________________________________________________________________________________</p><p>Reassess therapy in 1 week/Titrate to at least &frac12; max dose or add additional agent</p></td></tr></tbody></table>Two arrows lead from this box to two boxes below it. The arrow to the left is labeled "BP <130/80 mmHg" and points to the small box that reads: <table border="1" cellpadding="8" cellspacing="0" summary="layout" width="20%"><tbody><tr><td align="center"><u>Continue Therapy</u><br />BP Check Every Visit</td></tr></tbody></table>The arrow to the right is labeled "BP >130/80 mmHg" and points to a box that reads: <table border="1" cellpadding="8" cellspacing="0" summary="layout" width="80%"><tbody><tr><td align="center"><strong>Add:</strong> Medication not chosen from above<br /><strong>OR/</strong>Consider discontinuation IF SBP doesn't drop by 10 or DBP doesn't drop by 5<br />OR/ Go to Alternative Treatment**</td></tr></tbody></table>Two arrows lead from this box. The arrow to the left is labeled "BP <130/80 mmHg" and points to the small box that reads: <table border="1" cellpadding="8" cellspacing="0" summary="layout" width="20%"><tbody><tr><td align="center"><u>Continue Therapy</u><br />BP Check Every Visit</td></tr></tbody></table>The arrow to the right is labeled "BP >130/80 mmHg" and points back up to the box that reads: <table border="1" cellpadding="8" cellspacing="0" summary="layout" width="80%"><tbody><tr><td><p><strong>Add Diuretic OR Calcium Channel Blocker (CCB) OR Beta Blocker<br />If Diuretic Chosen:</strong> (Preferred if no other compelling indciations)</p><blockquote>Creatinine <1.8mg/dl Creatinine >1.8md/dl<br />Thiazide diuretic* Loop Diuretic<br />(*Max. dose 25md Hydrochlorothiazide or equivalent)</blockquote><p><strong>If Beta Blocker Chosen:</strong> (Strongly recommended if history of MI)<br />—Choose beta blocker without intrinsic sympathomimetic activity</p><p><strong>If CCB Chosen:</strong></p><blockquote><strong>If Diltiazem or Verapamil Chosen:</strong></blockquote><p>Pulse and conduction effects should be considered if combined with B blocker</p><p>___________________________________________________________________________________________</p><p>Reassess therapy in 1 week/Titrate to at least &frac12; max dose or add additional agent</p></td></tr></tbody></table><strong>Table 1</strong> <table border="1" cellpadding="8" cellspacing="0" summary="layout" width="80%"><tbody><tr><td><p><strong>Microalbuminuria/Proteinuria</strong></p><ul><li>In Type 2 patient, an ACEi or angiotensin receptor blocker (ARB) should be used first line.</li><li>In Type 1 patients, an ACEi is recommended to reduce protein excretion.</li><li>Concsider the use of verapamil or ditiazem in patient with proteinuria unable to tolerate ACEi or ARBs.</li></ul></td></tr></tbody></table><p class="size2"><a href="/prevention/curriculum/chroniccaremodel/chronic2a.html">Return to Document</a></p></div>
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<div id="page-reviewed" class="body-copy-italic">Page last reviewed October 2014</div>
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<div id="page-created" class="body-copy-italic">Page originally created January 2008</div>
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<p>
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<span class="citation-hdr">Internet Citation:</span> Hypertension Algorithm for Diabetes in Adults Goal BP <130/80. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.<br>
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<span class="citation-url">https://archive.ahrq.gov/professionals/education/curriculum-tools/chroniccaremodel/chronic2a10.html</span>
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