Summary : This flowchart outlines the management of hypertension in glomerular disease, detailing target blood pressure goals, general lifestyle recommendations, and a tiered medication strategy with specific caveats and additional strategies. flowchart: # Nodes : • Management of hypertension in glomerular disease (rectangle, top central node) • Target blood pressure (rectangle, left branch) – Adults: SBP <120 mm Hg – Children: 24 h MAP <50th percentile for age, sex, and height or local standards • General recommendations (rectangle, right branch) – Salt restriction – Weight normalization – Regular exercise – Smoking cessation • Medications (rectangle, central lower node) – First-line: angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers • Use combination with caution due to possible hyperkalemia and/or acute kidney injury • Caveats: – Educate regarding discontinuation if volume depletion (vomiting, diarrhea, sweating from high fever/strenuous exercise) – Monitor serum creatinine and potassium frequently; discontinue if serum creatinine rises >30%; lower increment may be acceptable hemodynamic change – Potassium-lowering medications may be considered to optimize tolerability of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker treatment – Second-line: mineralocorticoid receptor antagonists • May be useful for antihypertensive and anti-proteinuric effects, particularly in patients who are intolerant to angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers • May require discontinuation for hyperkalemia, although salvage therapy with potassium binders may be feasible – Additional strategies: • Use of antihypertensive agents without angiotensin blocking activity to achieve the goal blood pressure also contributes to proteinuria control • Loop and thiazide diuretics aid in blood pressure control and the management of hyperkalemia, and enhance renin-angiotensin-aldosterone system inhibitor antiproteinuric effects # Connectors : • Downward arrows from "Management of hypertension in glomerular disease" to "Target blood pressure", "General recommendations", and "Medications". • "Medications" node branches into "First-line", "Second-line", and "Additional strategies" sections. # Layout : • Central top node ("Management of hypertension in glomerular disease") with three downward branches: left ("Target blood pressure"), right ("General recommendations"), and center ("Medications"). • "Medications" node is subdivided into first-line, second-line, and additional strategies, each with bullet-pointed details. # Analysis : • The flowchart provides a structured, stepwise approach to managing hypertension in glomerular disease, emphasizing both non-pharmacological and pharmacological interventions. • It prioritizes angiotensin system blockers as first-line therapy, with careful monitoring for adverse effects, and offers alternatives and adjuncts for patients with intolerance or inadequate response. • The chart highlights the importance of individualized care, monitoring, and lifestyle modification alongside medication.

Summary : This flowchart outlines the recommended management pathway for patients with office blood pressure (BP) ≥140/90 mmHg despite taking three or more BP-lowering medications at maximally tolerated doses, including a diuretic, according to the European Society of Cardiology (ESC) guidelines. It details steps for referral, medication optimization, and further interventions for true treatment-resistant hypertension. flowchart: # Nodes : • Office BP ≥140/90 mmHg despite 3 or more BP-lowering medications at maximally tolerated doses, including a diuretic (rounded rectangle, top) • Referral to hypertension centre should be considered (rounded rectangle, yellow) – Exclusion of secondary and pseudo-resistant hypertension – Treatment optimization of BP-lowering medications (ideally three-drug SPC) – (Class IIa) • True treatment-resistant hypertension (rectangle, light blue) • Spironolactone (rounded rectangle, yellow) – If spironolactone is not tolerated: eplerenone – (Class IIa) • Beta-blocker (if not already recommended for a compelling indication) (rounded rectangle, yellow) – (Class IIa) • Intensification of pharmacotherapy (rounded rectangle, yellow, left branch) – Alpha blockers – Centrally acting BP-lowering drugs – K+ sparing diuretics – Others – (Class IIa) • Shared risk-benefit discussion and multidisciplinary assessment (circle, handshake icon, centre) • Renal denervation (rounded rectangle, orange, right branch) – (Class IIb) • If BP remains uncontrolled (arrow leading to shared risk-benefit discussion node) # Connectors : • Downward arrows connect each step in sequence from top to bottom. • After beta-blocker, two branches: – Left: Intensification of pharmacotherapy – Right: Interventional therapy (Renal denervation) • Both branches connect to shared risk-benefit discussion and multidisciplinary assessment. • If BP remains uncontrolled, loop back to shared risk-benefit discussion node. # Layout : • Vertical flow from top (initial criteria) to bottom (shared assessment). • After beta-blocker, splits into two parallel branches (pharmacotherapy intensification on left, interventional therapy on right). • Central node (shared risk-benefit discussion) connects both branches. • Colour coding: yellow for recommended steps, orange for interventional therapy, light blue for diagnostic confirmation. # Analysis : • The flowchart provides a stepwise escalation for managing resistant hypertension, starting with referral and medication optimization, then adding spironolactone or eplerenone, followed by beta-blockers if indicated. • If BP remains uncontrolled, further intensification of pharmacotherapy or consideration of renal denervation is recommended, with shared decision-making and multidisciplinary assessment. • The process emphasizes exclusion of secondary causes and optimization before moving to advanced therapies. • Class IIa recommendations dominate, with renal denervation as a Class IIb option. • The workflow is linear with a split into two parallel escalation pathways, converging on shared decision-making.

Summary : This flowchart presents the ASCVD (Atherosclerotic Cardiovascular Disease) risk reduction algorithm for hypertension management, outlining stepwise goals, interventions, and medication options. flowchart: # Nodes : • GOAL: <130 SYSTOLIC/<80 DIASTOLIC mmHg (rectangle, blue) • LIFESTYLE INTERVENTION: Decrease Sodium Intake | Diet (DASH, Mediterranean) | Physical Activity | Achieve Optimal Weight (rectangle, blue) • ARB OR ACE: For initial blood pressure >150/100 mmHg, consider starting DUAL THERAPY combined with another agent below (rectangle, purple) • TITRATE MEDICATION DOSE OR ADD ON THERAPY EVERY 2-3 MONTHS TO REACH GOAL (rectangle, orange) • THIAZIDE | CALCIUM CHANNEL BLOCKER (rectangle, blue) • COMBINED α-β BLOCKER | β1 SELECTIVE BLOCKER | MINERALOCORTICOID RA (rectangle, orange) • ADDITIONAL ANTIHYPERTENSIVE AGENTS: CENTRAL α2 AGONIST | PERIPHERAL α1-BLOCKER | HYDRALAZINE (rectangle, red) # Connectors : • Top-down linear flow from goal setting, lifestyle intervention, initial medication choice, titration, and escalation to additional agents. • ARB/ACE node includes a branch for dual therapy if initial BP is >150/100 mmHg. • Medication escalation proceeds in order: thiazide/calcium channel blocker → combined blockers/mineralocorticoid RA → additional antihypertensive agents. # Layout : • Vertically stacked rectangles, each representing a step in the algorithm. • Colour-coded sections: blue for goals/lifestyle/first-line agents, purple for ARB/ACE, orange for titration/combination, red for additional agents. • Footnotes and references are included at the bottom for clinical context and special considerations. # Analysis : • The algorithm emphasizes a stepwise approach: starting with lifestyle changes, then progressing to medication based on blood pressure severity and response. • Dual therapy is recommended for very high initial BP (>150/100 mmHg). • Medication titration and escalation are structured, with clear options for combination and additional agents. • Colour coding visually separates intervention types and escalation steps. • The flowchart provides a comprehensive, guideline-based pathway for hypertension management in ASCVD risk reduction.