{"id":9675,"date":"2026-03-10T16:55:30","date_gmt":"2026-03-10T13:55:30","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=9675"},"modified":"2026-03-10T16:55:30","modified_gmt":"2026-03-10T13:55:30","slug":"multisociety-jordan-national-hypertension-clinical-protocols-initiative","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/multisociety-jordan-national-hypertension-clinical-protocols-initiative\/","title":{"rendered":"Multisociety Jordan National Hypertension Clinical Protocols Initiative"},"content":{"rendered":"
Multisociety Jordan National Hypertension Clinical Protocols Initiative<\/div>\n
A Collaborative Program of Nine Jordanian Medical Societies Coordinated by the Jordan Cardiac Society (JCS)<\/div>\n
<\/div>\n
Participating Societies:<\/div>\n
Jordan Cardiac Society (JCS)<\/div>\n
Jordan Atherosclerosis Society (JAS)<\/div>\n
Jordan Society of General Practitioners (JSGP)<\/div>\n
Jordan Society of Internal Medicine (JSIM)<\/div>\n
Jordan Society of Nephrology (JSN)<\/div>\n
Jordan Society of Family Medicine (JSFM)<\/div>\n
Jordan Emergency Medicine Society (JEMS)<\/div>\n
Jordan Endocrine and Diabetes Society (JEDS)<\/div>\n
Jordan Nutrition Society (JNS)<\/div>\n
<\/div>\n
<\/div>\n
Based on:<\/div>\n
ESH\/ESC 2024<\/div>\n
ACC\/AHA 2025 and CCS Updates,\u00a0 and<\/div>\n
International Society of Hypertension 2020<\/div>\n
<\/div>\n
Preface :<\/div>\n
<\/div>\n
Each population requires its most suitable guideline, and the best blood pressure categorization \u2026<\/div>\n
(In Jordan, many patients are inherently high risk due to prevalent cardiovascular factors, yet awareness and access to consistent treatment remain limited. Therefore, blood pressure categorization and treatment strategies must balance scientific evidence with local realities.)<\/div>\n
<\/div>\n
\u20071.\u2060 \u2060Diagnosis Protocol<\/div>\n
<\/div>\n
Hypertension is diagnosed when:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Office blood pressure \u2265140\/90 mmHg , Confirmed on at least two separate visits(This corresponds approximately to home BP \u2265135\/85 mmHg)<\/div>\n
<\/div>\n
OR on<\/div>\n
\u2022\u2060\u00a0 \u2060Home blood pressure \u2265135\/85 mmHg<\/div>\n
<\/div>\n
OR on<\/div>\n
\u2022\u2060\u00a0 \u206024-hour ambulatory blood pressure monitoring \u2265130\/80 mmHg<\/div>\n
<\/div>\n
Except If BP severe or there is target-organ damage, hypertension may be diagnosed immediately in one visit and treated without waiting for repeated visits.<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Office \u2265140\/90 with home <135\/85 \u2192 suggests white-coat hypertension \u201cWCH\u201d (elevated office BP \u2265140\/90 with normal home BP <135\/85).<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060WCH Occurs in about 15\u201330% of patients with high office readings.<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Important to avoid misdiagnosis and unnecessary treatment.<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Cardiovascular risk is higher than normal BP but lower than sustained hypertension.<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060About 30\u201340% may progress to true hypertension over time.<\/div>\n
<\/div>\n
Accurate measurement is essential:<\/div>\n
\u2022\u2060\u00a0 \u2060Use validated upper-arm automated devices<\/div>\n
\u2022\u2060\u00a0 \u2060Avoid cuffless devices<\/div>\n
\u2022\u2060\u00a0 \u2060Ensure correct cuff size<\/div>\n
\u2022\u2060\u00a0 \u2060Confirm diagnosis with home or ambulatory monitoring whenever possible<\/div>\n
<\/div>\n
Hypertension Screening (Adults and Children)<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Adults: Screen all adults \u226518 years during routine clinical visits.<\/div>\n
\u2022\u2060\u00a0 \u2060Normal BP: recheck every3 years; elevated BP: reassess annually or sooner.<\/div>\n
\u2022\u2060\u00a0 \u2060High-risk adults (diabetes, CKD, obesity, family history): screen more frequently.<\/div>\n
\u2022\u2060\u00a0 \u2060Children and adolescents: begin BP screening from age 3 years, once yearly.<\/div>\n
\u2022\u2060\u00a0 \u2060High-risk children (obesity, kidney disease, diabetes, congenital heart disease): measure BP at every visit.<\/div>\n
<\/div>\n
When to Suspect Secondary Hypertension:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Resistant hypertension despite \u22653 medications<\/div>\n
\u2022\u2060\u00a0 \u2060Onset of hypertension before age 40<\/div>\n
\u2022\u2060\u00a0 \u2060Abrupt onset or sudden worsening of previously controlled hypertension<\/div>\n
\u2022\u2060\u00a0 \u2060Hypokalemia<\/div>\n
\u2022\u2060\u00a0 \u2060Worsening\u00a0 in renal function<\/div>\n
\u2022\u2060\u00a0 \u2060Asymmetric kidney size<\/div>\n
\u2022\u2060\u00a0 \u2060Persistent diastolic hypertension after age >55 years<\/div>\n
\u2022\u2060\u00a0 \u2060Disproportionate target-organ damage for the level of BP<\/div>\n
\u2022\u2060\u00a0 \u2060Non-Dipping Nocturnal Blood Pressure<\/div>\n
<\/div>\n
Most Common Causes of Secondary Hypertension<\/div>\n
<\/div>\n
(Approximate clinical frequency)<\/div>\n
<\/div>\n
Common<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Primary aldosteronism<\/div>\n
\u2248 5\u201310% of all hypertension<\/div>\n
\u2248 15\u201325% of resistant hypertension<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Obstructive sleep apnea<\/div>\n
\u2248 5\u201310%<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Chronic kidney disease (renal parenchymal disease)<\/div>\n
\u2248 3\u20135%<\/div>\n
<\/div>\n
Less common :<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Renal artery stenosis<\/div>\n
\u2248 1\u20135%(Unilateral stenosis \u2192 usually hypertension only.<\/div>\n
Bilateral stenosis \u2192 hypertension + renal failure risk)<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Thyroid disorders<\/div>\n
\u2248 1\u20132%<\/div>\n
<\/div>\n
Rare<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Pheochromocytoma \/ paraganglioma<\/div>\n
\u2248 0.1\u20130.6%<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Cushing syndrome<\/div>\n
< 1%<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Hyperparathyroidism<\/div>\n
< 1%<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Coarctation of the aorta<\/div>\n
< 0.1%<\/div>\n
<\/div>\n
Key Clinical Message<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Secondary hypertension accounts for about 5\u201310% of all hypertension.<\/div>\n
\u2022\u2060\u00a0 \u2060Approximately 90\u201395% of patients have primary (essential) hypertension.<\/div>\n
<\/div>\n
Initial Evaluation for Suspected Secondary Hypertension<\/div>\n
<\/div>\n
Basic tests for all patients<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Serum creatinine and eGFR<\/div>\n
\u2022\u2060\u00a0 \u2060Serum electrolytes (especially potassium)<\/div>\n
\u2022\u2060\u00a0 \u2060Urinalysis \u00b1 urine albumin\/creatinine ratio<\/div>\n
\u2022\u2060\u00a0 \u2060Fasting glucose or HbA1c<\/div>\n
\u2022\u2060\u00a0 \u2060Lipid profile<\/div>\n
<\/div>\n
Screening for common secondary causes<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Aldosterone\u2013Renin Ratio (ARR) \u2192 screen for primary aldosteronism<\/div>\n
\u2022\u2060\u00a0 \u2060Sleep study when obstructive sleep apnea is suspected<\/div>\n
\u2022\u2060\u00a0 \u2060TSH \u2192 screen for thyroid disorders<\/div>\n
<\/div>\n
Renal evaluation<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Renal ultrasound (kidney size and asymmetry)<\/div>\n
\u2022\u2060\u00a0 \u2060Renal artery imaging (CT angiography \/ MR angiography \/ Doppler) when renal artery stenosis is suspected<\/div>\n
<\/div>\n
Endocrine evaluation when clinically suspected( Plasma free metanephrines \u2192 pheochromocytoma)<\/div>\n
<\/div>\n
Important principle<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Testing should be guided by clinical suspicion, not performed routinely in all patients with hypertension.<\/div>\n
<\/div>\n
\u20072.\u2060 \u2060Cardiovascular Risk Assessment Protocol<\/div>\n
<\/div>\n
Every patient must undergo cardiovascular risk assessment.<\/div>\n
<\/div>\n
You can use one formal calculator:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060PREVENT or \/ASCVD (American model)<\/div>\n
OR<\/div>\n
\u2022\u2060\u00a0 \u2060SCORE2 or SCORE2-OP (European model)<\/div>\n
<\/div>\n
You can also estimate CV risk for the patient clinically. Do not wait for a calculator when risk is clinically obvious:<\/div>\n
<\/div>\n
Automatically treat as High Risk if the patient has:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Established atherosclerotic vascular disease<\/div>\n
\u2022\u2060\u00a0 \u2060Diabetes<\/div>\n
\u2022\u2060\u00a0 \u2060Chronic kidney disease (estimated glomerular filtration rate <60 or albuminuria)<\/div>\n
\u2022\u2060\u00a0 \u2060Target organ damage<\/div>\n
\u2022\u2060\u00a0 \u2060Multiple major cardiovascular risk factors<\/div>\n
\u00a0Or 2 major risk factors of the following :<\/div>\n
\u2022\u2060\u00a0 \u2060Hypertension<\/div>\n
\u2022\u2060\u00a0 \u2060Smoking<\/div>\n
\u2022\u2060\u00a0 \u2060Diabetes<\/div>\n
\u2022\u2060\u00a0 \u2060Dyslipidemia<\/div>\n
\u2022\u2060\u00a0 \u2060Family history of premature vascular disease<\/div>\n
<\/div>\n
\u20073.\u2060 \u2060When to Start Medication<\/div>\n
<\/div>\n
Start immediately if:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Blood pressure \u2265160\/100 mmHg<\/div>\n
<\/div>\n
Start at:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060\u2265140\/90 mmHg<\/div>\n
<\/div>\n
Start earlier (\u2265130\/80 mmHg) if High Risk:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Diabetes<\/div>\n
\u2022\u2060\u00a0 \u2060Chronic kidney disease<\/div>\n
\u2022\u2060\u00a0 \u2060Established vascular disease<\/div>\n
\u2022\u2060\u00a0 \u2060High calculated cardiovascular risk<\/div>\n
\u2022\u2060\u00a0 \u2060Multiple major risk factors<\/div>\n
<\/div>\n
Lifestyle treatment is mandatory for all patients.<\/div>\n
<\/div>\n
\u20074.\u2060 \u2060Treatment Targets<\/div>\n
<\/div>\n
General target for low risk patients:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060<140\/90 mmHg<\/div>\n
(Preferred target if tolerated:<\/div>\n
\u2022\u2060\u00a0 \u2060<130\/80 mmHg)<\/div>\n
<\/div>\n
High-risk patients:<\/div>\n
\u2022\u2060\u00a0 \u2060Actively aim for <130\/80 mmHg<\/div>\n
<\/div>\n
Elderly or frail:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Individualize<\/div>\n
\u2022\u2060\u00a0 \u2060Avoid systolic blood pressure <120 mmHg unless well tolerated<\/div>\n
Safety always comes first.<\/div>\n
<\/div>\n
\u20075.\u2060 \u2060Drug Therapy Protocol<\/div>\n
<\/div>\n
Stage 1 (140\u2013159\/90\u201399):<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Monotherapy acceptable<\/div>\n
\u2022\u2060\u00a0 \u2060Low-dose single-pill combination encouraged<\/div>\n
<\/div>\n
Stage 2 (\u2265160\/100) or stage 3 180\/110 :<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Start dual or triple low dose\u00a0 immediately<\/div>\n
<\/div>\n
Preferred first-line classes:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Angiotensin-converting enzyme inhibitor OR angiotensin receptor blocker<\/div>\n
\u2022\u2060\u00a0 \u2060Long-acting calcium channel blocker<\/div>\n
\u2022\u2060\u00a0 \u2060Thiazide or thiazide-like diuretic (chlorthalidone or indapamide preferred)<\/div>\n
<\/div>\n
Use single-pill combinations whenever possible.<\/div>\n
<\/div>\n
\u20076.\u2060 \u2060Resistant Hypertension Protocol<\/div>\n
<\/div>\n
Definition:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Blood pressure \u2265140\/90 mmHg despite three drugs including a diuretic<\/div>\n
OR<\/div>\n
\u2022\u2060\u00a0 \u2060Controlled blood pressure requiring four or more drugs<\/div>\n
<\/div>\n
Step 1 \u2013 Confirm true resistance:<\/div>\n
\u2022\u2060\u00a0 \u2060Assess medication adherence<\/div>\n
\u2022\u2060\u00a0 \u2060Evaluate for secondary hypertension<\/div>\n
<\/div>\n
Step 2 \u2013 Review contributing factors:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Excess sodium intake<\/div>\n
\u2022\u2060\u00a0 \u2060Obesity<\/div>\n
\u2022\u2060\u00a0 \u2060Alcohol excess<\/div>\n
\u2022\u2060\u00a0 \u2060Nonsteroidal anti-inflammatory drugs<\/div>\n
\u2022\u2060\u00a0 \u2060Hormonal therapy<\/div>\n
\u2022\u2060\u00a0 \u2060Steroids<\/div>\n
\u2022\u2060\u00a0 \u2060Obstructive sleep apnea<\/div>\n
<\/div>\n
Step 3 \u2013 Optimize regimen:<\/div>\n
<\/div>\n
Ensure combination includes:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Renin-angiotensin system blocker<\/div>\n
\u2022\u2060\u00a0 \u2060Long-acting calcium channel blocker<\/div>\n
\u2022\u2060\u00a0 \u2060Thiaszide or Thiazide-like (Indapamide)diuretic<\/div>\n
<\/div>\n
If severe renal impairment\u00a0 is present, consider loop diuretic:<\/div>\n
(When eGFR <30:<\/div>\n
\u2022 Thiazide \/ thiazide-like diuretics lose effectiveness<\/span><\/div>\n
\u2022 Loop diuretics become preferred)<\/span><\/div>\n
<\/div>\n
Step 4 \u2013 Add-On Therapy (If 4 Drugs Are Needed)<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Spironolactone \u2014 first-line add-on therapy if serum K <5 mmol\/L and renal function permits<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Beta-blocker may be considered particularly when:<\/div>\n
\u2013 Coronary artery disease<\/div>\n
\u2013 Heart failure<\/div>\n
\u2013 Atrial fibrillation or tachyarrhythmia<\/div>\n
\u2013 High sympathetic tone \/ tachycardia<\/div>\n
<\/div>\n
Step 5 \u2013 Evaluate secondary causes systematically.<\/div>\n
<\/div>\n
Step 6 Hypertensive Crisis Protocol<\/div>\n
<\/div>\n
Severe Asymptomatic Hypertension(Urgency older term): Evaluation and Treatment<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060By definition, there is no acute target-organ injury<\/div>\n
Evaluation<\/div>\n
\u2022 Perform history and physical examination to distinguish severe asymptomatic hypertension from hypertensive emergency<\/span><\/div>\n
\u2022 Focus on:<\/span><\/div>\n
\u2022 medication adherence as if severe BP elevation occurs due to medication nonadherence, restarting the patient\u2019s usual antihypertensive therapy may be all that is required.<\/span><\/div>\n
\u2022\u2060\u00a0 \u2060Look for signs of target-organ damage:<\/div>\n
\u2022 neurologic deficits<\/span><\/div>\n
\u2022 papilledema<\/span><\/div>\n
\u2022 pulmonary edema<\/span><\/div>\n
\u2022 arrhythmia<\/span><\/div>\n
\u2022 unequal pulses<\/span><\/div>\n
\u2022 renal dysfunction<\/span><\/div>\n
<\/div>\n
\u2022 Look for signs of target-organ damage:<\/span><\/div>\n
\u2022 neurologic deficits<\/span><\/div>\n
\u2022 papilledema<\/span><\/div>\n
\u2022 pulmonary edema<\/span><\/div>\n
\u2022 arrhythmia<\/span><\/div>\n
\u2022 unequal pulses(Aortic dissection)<\/span><\/div>\n
\u2022 renal dysfunction<\/span><\/div>\n
<\/div>\n
Blood Pressure Measurement<\/div>\n
\u2022 Measure in both arms initially<\/span><\/div>\n
\u2022 Use the higher reading<\/span><\/div>\n
<\/div>\n
Importance of Rest<\/div>\n
\u2022 A 30-minute rest period is recommended when BP is severely elevated<\/span><\/div>\n
\u2022 In more than 30% of patients, BP falls to an acceptable level without intervention after rest<\/span><\/div>\n
<\/div>\n
Preferred Oral Agents for Severe Asymptomatic Hypertension-Urgency cases:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Captopril \u2014 onset 15\u201330 min (rapid BP reduction; commonly used in ED).<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Nifedipine ER (extended-release) \u2014 onset 30\u201360 min (avoid short-acting nifedipine; exception: in pregnancy it may be used orally (swallowed) in severe,not SL).<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Prazosin \u2014 onset 1\u20132 h (use cautiously due to risk of first-dose orthostatic hypotension; start with a low initial dose and monitor blood pressure).<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Amlodipine \u2014 onset 4\u20136 h (preferred at discharge for longer BP control).<\/div>\n
<\/div>\n
In Hypertensive Emergency<\/div>\n
<\/div>\n
Management principles<\/div>\n
\u2022 Admit to ICU \/ monitored unit<\/span><\/div>\n
\u2022 Use IV antihypertensives<\/span><\/div>\n
\u2022 Reduce MAP by 20\u201325% in the first hour<\/span><\/div>\n
\u2022 Then reach 160\/100\u2013110 mmHg within 2\u20136 hours<\/span><\/div>\n
\u2022 Normalize BP gradually over 24\u201348 h<\/span><\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060If IV nitroglycerin is the only available agent, it can be used for hypertensive emergency but is not ideal for all situations.<\/div>\n
<\/div>\n
Best indications:<\/div>\n
\u2022\u2060\u00a0 \u2060Acute pulmonary edema<\/div>\n
\u2022\u2060\u00a0 \u2060Acute coronary syndrome<\/div>\n
<\/div>\n
Not preferred for:<\/div>\n
\u2022\u2060\u00a0 \u2060Stroke\u00a0 or ICH\u2192 (Nicardipine or Labetalol preferred)<\/div>\n
\u2022\u2060\u00a0 \u2060Hypertensive encephalopathy \u2192 (Nicardipine or Labetalol preferred)<\/div>\n
\u2022\u2060\u00a0 \u2060Aortic dissection \u2192 (Beta-blocker first: Esmolol or Labetalol; Nitroprusside may be added if BP remains uncontrolled)<\/div>\n
<\/div>\n
Dose:<\/div>\n
\u2022\u2060\u00a0 \u2060Start 5 mcg\/min IV infusion<\/div>\n
\u2022\u2060\u00a0 \u2060Titrate every 5 minutes<\/div>\n
<\/div>\n
Goal:<\/div>\n
\u2022\u2060\u00a0 \u2060Reduce BP 20\u201325% (to ~160\/100)in the first hour, then gradually.<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060IV Hydralazine: direct arterial vasodilator.<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Mainly used in hypertensive emergencies of pregnancy (preeclampsia\/eclampsia).<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Dose: 5\u201310 mg IV bolus, repeat every 20\u201330 min if needed.<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Limitations: unpredictable BP drop and reflex tachycardia; therefore not first-line in most hypertensive emergencies.<\/div>\n
<\/div>\n
General Rule (ESH-Aligned)<\/div>\n
\u2022 Reduce mean arterial pressure (MAP) by no more than 20\u201325% within the first hour.<\/span><\/div>\n
\u2022 Avoid rapid or excessive reduction to prevent cerebral, coronary, or renal ischemia.<\/span><\/div>\n
<\/div>\n
Exceptions \u2013 Condition-Specific Targets<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Aortic Dissection<\/div>\n
\u2022 Immediate reduction of systolic BP to <120 mmHg within 20 minutes<\/span><\/div>\n
\u2022 Control heart rate to <60 bpm<\/span><\/div>\n
\u2022 Initiate beta-blocker before vasodilator when possible<\/span><\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Acute Ischemic Stroke ( No Thrombolysis)<\/div>\n
\u2022 Do not lower BP unless >220\/120 mmHg<\/span><\/div>\n
\u2022 If treatment is required, reduce cautiously:<\/span><\/div>\n
\u2022 \u226415% during the first 24 hours<\/span><\/div>\n
<\/div>\n
Blood Pressure Control Before Thrombolysis (Acute Ischemic Stroke)<\/div>\n
<\/div>\n
Eligibility for thrombolysis requires:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060BP <185\/110 mmHg before thrombolytic therapy<\/div>\n
<\/div>\n
If BP is above this level:<\/div>\n
<\/div>\n
Lower blood pressure cautiously using short-acting IV agents:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Labetalol<\/div>\n
\u2013 10\u201320 mg IV over 1\u20132 minutes<\/div>\n
\u2013 May repeat once<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Nicardipine infusion<\/div>\n
\u2013 Start 5 mg\/h IV<\/div>\n
\u2013 Increase by 2.5 mg\/h every 5\u201315 min<\/div>\n
\u2013 Maximum 15 mg\/h<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Clevidipine infusion (where available)<\/div>\n
<\/div>\n
After thrombolysis<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Maintain BP <180\/105 mmHg for the first 24 hours<\/div>\n
<\/div>\n
Important principle<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060BP reduction should be controlled and modest<\/div>\n
\u2022\u2060\u00a0 \u2060Avoid rapid or excessive lowering to prevent cerebral hypoperfusion<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Intracerebral Hemorrhage (ICH)<\/div>\n
\u2022 Target systolic BP \u2248140 mmHg<\/span><\/div>\n
\u2022 Achieve reduction within the first 6 hour<\/span><\/div>\n
\u2022 If stable, then you further reduce blood pressure more slowly to approximately 160\/100\u2013110 mmHg over the next 2\u20136 hours.<\/span><\/div>\n
\u2022 Gradual normalization may then occur over the following 24\u201348 hours.<\/span><\/div>\n
<\/div>\n
The presence of organ damage defines the emergency, not the number alone.<\/div>\n
<\/div>\n
8.<\/div>\n
<\/div>\n
10.\u2060 \u2060Hypertension in pregnancy:<\/div>\n
<\/div>\n
SBP \u2265140 mmHg or DBP \u226590 mmHg.<\/div>\n
\u2022 Gestational hypertension: occurs after 20 weeks with previously normal BP.<\/span><\/div>\n
\u2022 Chronic hypertension: present before pregnancy or before 20 weeks.<\/span><\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Most international guidelines (ESC, NICE, WHO, Canada):<\/div>\n
\u2022 Start treatment at \u2265140\/90 mmHg.<\/span><\/div>\n
\u2022 Target often <140\/90 mmHg<\/span><\/div>\n
<\/div>\n
Preeclampsia diagnosis(Emerency case ) :<\/div>\n
\u2022 BP \u2265140\/90 mmHg after 20 weeks<\/span><\/div>\n
\u2022 Plus proteinuria or organ dysfunction, including:<\/span><\/div>\n
\u2022 renal impairment<\/span><\/div>\n
\u2022 liver dysfunction<\/span><\/div>\n
\u2022thrombocytopenia<\/span><\/div>\n
\u2022 neurological symptoms<\/span><\/div>\n
<\/div>\n
Most international guidelines consider the following agents as preferred options:<\/div>\n
\u2022 Labetalol<\/span><\/div>\n
\u2022 Methyldopa<\/span><\/div>\n
\u2022 Nifedipine<\/span><\/div>\n
<\/div>\n
Additional option (especially in acute severe hypertension):<\/div>\n
\u2022 Hydralazine (IV), particularly for acute BP control in severe hypertension during pregnancy.<\/span><\/div>\n
<\/div>\n
Oral hydralazine is not contraindicated, but it is not preferred because safer and more predictable agents are available for maintenance therapy in pregnancy.<\/div>\n
<\/div>\n
Medications to avoid<\/div>\n
\u2022 Renin\u2013angiotensin system blockers<\/span><\/div>\n
\u2022 ACE inhibitors<\/span><\/div>\n
\u2022 ARBs<\/span><\/div>\n
\u2022 direct renin inhibitors<\/span><\/div>\n
<\/div>\n
Acute Severe Hypertension in Pregnancy<\/div>\n
<\/div>\n
(for Multisociety Hypertension Protocol)<\/div>\n
Multidisciplinary team :<\/div>\n
\u00a0 \u00a0 \u00a0 \u2022\u00a0 \u00a0 \u00a0obstetricians<\/div>\n
\u2022 cardiologists<\/span><\/div>\n
\u2022 nephrologists<\/span><\/div>\n
\u2022 nurses and midwives<\/span><\/div>\n
Definition<\/div>\n
\u2022 Severe hypertension:<\/span><\/div>\n
SBP \u2265160 mmHg or DBP \u2265110 mmHg<\/div>\n
\u2022 Requires urgent treatment within 30\u201360 minutes to reduce risk of:<\/span><\/div>\n
\u2022 maternal stroke<\/span><\/div>\n
\u2022 placental abruption<\/span><\/div>\n
\u2022 fetal compromise\u00a0\u00a0<\/span><\/div>\n
<\/div>\n
First-Line Drug Treatment for acute severe hypertension in pregnancy :<\/div>\n
<\/div>\n
Immediate-Release Oral Nifedipine<\/div>\n
\u2022 Dose: 10\u201320 mg orally (swallowed)<\/span><\/div>\n
\u2022 Do NOT give sublingually<\/span><\/div>\n
\u2022 Repeat after 20 minutes if BP remains \u2265160\/110<\/span><\/div>\n
\u2022 Maximum: 30 mg in the first hour<\/span><\/div>\n
\u2022 Onset: ~5\u201310 minutes\u00a0\u00a0<\/span><\/div>\n
<\/div>\n
Role<\/div>\n
\u2022 One of the first-line therapies for acute severe hypertension in pregnancy<\/span><\/div>\n
\u2022 Particularly useful when IV access is not available or delayed\u00a0\u00a0<\/span><\/div>\n
<\/div>\n
Alternative First-Line Options<\/div>\n
\u2022 IV Labetalol<\/span><\/div>\n
\u2022 IV Hydralazine<\/span><\/div>\n
<\/div>\n
All three agents are recommended by major obstetric guidelines.<\/div>\n
<\/div>\n
Important Administration Note<\/div>\n
\u2022 Immediate-release nifedipine must be given orally (swallowed \u201cnot\u201d SL).<\/span><\/div>\n
\u2022 Sublingual administration is not recommended because it may cause rapid hypotension and maternal\u2013fetal complications.\u00a0\u00a0<\/span><\/div>\n
<\/div>\n
Key Clinical Principle<\/div>\n
\u2022 Immediate-release nifedipine is accepted in obstetrics for acute severe hypertension.<\/span><\/div>\n
\u2022 It is generally avoided in other hypertensive emergencies because of the risk of uncontrolled BP reduction.<\/span><\/div>\n
<\/div>\n
Reference<\/div>\n
<\/div>\n
ACOG Committee Opinion No. 692 \u2013 Referenced by: ACC \/ AHA cardiovascular reviews .<\/div>\n
Emergent Therapy for Acute-Onset Severe Hypertension in Pregnancy<\/div>\n
https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537052\/CV<\/a><\/div>\n
<\/div>\n
<\/div>\n
12.\u2060 \u2060Lifestyle Protocol<\/div>\n
<\/div>\n
All patients:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Reduce sodium intake<\/div>\n
\u2022\u2060\u00a0 \u2060Increase dietary potassium if safe<\/div>\n
\u2022\u2060\u00a0 \u2060Maintain healthy weight<\/div>\n
\u2022\u2060\u00a0 \u2060Exercise regularly<\/div>\n
\u2022\u2060\u00a0 \u2060Stop smoking<\/div>\n
\u2022\u2060\u00a0 \u2060Limit alcohol<\/div>\n
<\/div>\n
Potassium-enriched salt may be considered in patients without hyperkalemia risk.<\/div>\n
<\/div>\n
13.\u2060 \u2060Nocturnal Hypertension Protocol<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Diagnosed only by ambulatory monitoring<\/div>\n
\u2022\u2060\u00a0 \u2060Associated with higher cardiovascular and renal risk<\/div>\n
\u2022\u2060\u00a0 \u2060Consider evening dosing<\/div>\n
\u2022\u2060\u00a0 \u2060Treat sleep apnea when present<\/div>\n
\u2022\u2060\u00a0 \u2060Avoid excessive lowering in elderly (<110\/65)<\/div>\n
<\/div>\n
Final Position \u2013 JCS 2026<\/div>\n
<\/div>\n
This document:<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Applies European diagnostic standards<\/div>\n
\u2022\u2060\u00a0 \u2060Integrates 2025 American updates<\/div>\n
\u2022\u2060\u00a0 \u2060Intensifies treatment in high-risk patients<\/div>\n
\u2022\u2060\u00a0 \u2060Emphasizes structured risk assessment<\/div>\n
\u2022\u2060\u00a0 \u2060Promotes single-pill strategy<\/div>\n
\u2022\u2060\u00a0 \u2060Incorporates maternal and stroke safety protocols<\/div>\n
\u2022\u2060\u00a0 \u2060Provides structured evaluation for resistant hypertension<\/div>\n
<\/div>\n
Core Messages<\/div>\n
<\/div>\n
Diagnose accurately.<\/div>\n
Assess cardiovascular risk in every patient.<\/div>\n
Treat earlier in high-risk individuals.<\/div>\n
Aim safely for below 130\/80 when appropriate.<\/div>\n","protected":false},"excerpt":{"rendered":"

Multisociety Jordan National Hypertension Clinical Protocols Initiative A Collaborative Program of Nine Jordanian Medical Societies Coordinated by the Jordan Cardiac Society (JCS) Participating Societies: Jordan Cardiac Society (JCS) Jordan Atherosclerosis Society (JAS) Jordan Society of General Practitioners (JSGP) Jordan Society of Internal Medicine (JSIM) Jordan Society of Nephrology (JSN) Jordan Society of Family Medicine (JSFM) […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-9675","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9675","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=9675"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9675\/revisions"}],"predecessor-version":[{"id":9676,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9675\/revisions\/9676"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=9675"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=9675"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=9675"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}