Hypertension

• Long-term (BP 140/90 or more: start with a 2-drug single pill; never two RAAS blockers): Telmisartan + Amlodipine, Telmisartan + Chlorthalidone, Amlodipine (single drug: low-risk grade 1, over 80 y or frail), Telmisartan, Chlorthalidone, Indapamide SR, Spironolactone (resistant: not controlled on 3 drugs), Metoprolol succinate (angina / heart failure / AF)
• Severe BP (180/120 or more) without organ damage — oral drugs, lower over 24–48 h; no IV drugs, no sublingual nifedipine; review within 1 wk: Amlodipine, Labetalol, Captopril
• Emergency (organ damage, ICU) — no more than 25% fall in the first hour, then 160/100 by 2–6 h, then 130–140 systolic over 24–48 h (aortic dissection: below 120 in the first hour): Labetalol IV, Nitroglycerin IV

First visit

• Blood glucose (fasting) or HbA1c — Diabetes screen.
• Serum creatinine (eGFR) and potassium — Baseline, before ACE inhibitor/ARB or diuretic.
• Urine routine and urine albumin–creatinine ratio — Kidney damage.
• Lipid profile — Cardiovascular risk.
• ECG — Left ventricular hypertrophy, old MI.

Only if indicated

• Echocardiography — ECG changes, breathlessness or a murmur.
• Fundoscopy — Severe hypertension, headache or visual symptoms.
• Aldosterone–renin ratio, renal Doppler, TSH — Young onset (under 30), resistant hypertension, low potassium (secondary causes).

Follow-up and monitoring

• Creatinine and potassium — Within 2–4 weeks of starting ACE inhibitor/ARB, diuretic or spironolactone, then yearly.
• Annual review — Creatinine, urine ACR, lipids, blood glucose; fundoscopy.