• Follow guideline for number that is most out of range
Blood pressure reading (mmHg) Follow-up
< 120 / 80 Recheck in 2 years
120 - 139 / 80 - 89 Recheck in 1 year
140 - 159 / 90 - 99 Recheck within 2 months
160 - 179 / 100 - 110 Recheck within 1 month
≥ 180 / ≥ 110 Treat now or recheck within 1 week











Arm circumference (cm) Cuff size
22 - 26 Small adult
(size 12X22 cm)
27 - 34 Standard adult
(size 16X30 cm)
35 - 44 Large adult
(size 16X36 cm)
45 - 52 Adult thigh cuff
(size 16X42 cm)

























  • Reference [50]
AHA 2018 recommendations for treating resistant hypertension
(Start with Step 1. Proceed to next step if BP does not reach target.)
Step 1
  • Ensure that patient meets definition
  • Maximize lifestyle interventions
    • Low sodium diet (< 2400 mg/day)
    • ≥ 6 hours of uninterrupted sleep
    • Weight loss and exercise
Step 2
Step 3
Step 4
Step 5
  • Add hydralazine 25 mg three times a day and titrate
  • Patients with heart failure and reduced EF should receive isosorbide mononitrate with hydralazine
  • Because of side effects (edema, tachycardia), hydralazine should be given with a beta blocker and loop diuretic
Step 6
  • Substitute minoxidil 2.5 mg two to three times a day for hydralazine and titrate
  • Because of side effects (edema, tachycardia), minoxidil should be given with a beta blocker and loop diuretic

















Lifestyle change Goal Approximate SBP reduction
Weight loss Maintain BMI 18 - 25 5 - 20 mmHg depending on starting weight
Adopt DASH diet Consume diet rich in fruits, vegetables, and low-fat dairy products 8 - 14 mmHg
Decrease sodium
(see sodium below)
Decrease daily sodium intake to ≤ 2400 mg 2 - 8 mmHg
Increase exercise At least 30 minutes a day, 5 days a week 4 - 9 mmHg
Moderate alcohol consumption No more than 2 drinks a day for males, and 1 drink a day for females 2 - 4 mmHg
Increase potassium intake 4 - 5 servings of fruits and vegetables will usually provide 1500 to >3000 mg (38 to >77 mEq) of potassium per day 4 - 5 mmHg
Stop smoking ∼7 mmHg [1,5,6,47]



Medication class Compelling indication
ACE inhibitors diabetes, heart failure, kidney disease
Aldosterone antagonists heart failure, liver failure, resistant hypertension, acne
ARBs diabetes, heart failure, kidney disease
Alpha-2 agonists hypertensive urgency
Alpha blockers benign prostatic hyperplasia
Beta blockers heart failure, heart attack, angina, atrial fibrillation, esophageal varices
Calcium channel blockers angina, atrial fibrillation (nondihydropyridines), black patients
Loop diuretics heart failure, kidney failure, liver failure
Thiazide diuretics heart failure, calcium-based kidney stones, black patients
Vasodilators angina, heart failure, resistant hypertension