Rule 1
Rule 1? Algorithm (CAD and HTN)
Rule 2? Algorithm (DM and HTN)
Rule 53 Algorithm (CHF and HTN)
Rule 54 Algorithm (Renal Failure/HTN)
Rule 55 (only HTN)
-----------------------
Rule 1?:
CAD, HTN, Recommend Beta Blocker therapy
No
Patient Allergic to Above Meds?
No
Beta Blocker on Medication List?
Yes
Yes
No
Yes
No
SBP < 140 AND DBP < 90?
Yes
Does problem list contain:
Hypertension
OR
Borderline Hypertension
No
BP entered within past 5 years?
Yes
No
Does Problem List Contain:
Coronary Artery Disease
No
Age > 17 years
No reminder given
Yes
Blood pressure uncontrolled, recommend increasing current dose of or adding new anti-hypertensive
Yes
Blood pressure uncontrolled, recommend increasing current dose of or adding new anti-hypertensive
Blood pressure uncontrolled recommend adding new or increasing dose of current anti-hypertensive
Yes
BP entered within past 5 years?
No
Does problem list contain:
Hypertension
OR
Borderline Hypertension
Yes
SBP < 130 AND DBP < 80?
No
Yes
No
Yes
Patient Allergic to Above Meds?
Yes
No
Serum Creatinine Available?
Yes
No
Rule 2?:
DM, HTN, Recommend ACE-I therapy
Yes
No
Most recent Creatinine < 3.0
No
Yes
Yes
ACE-I or ARB on Med List?
|Benazepril (1067); +Amlodipine (2456) |Quinapril 20mg/HCTZ 25mg (3646) |
|Benazepril/HCTZ (2484) |Ramipril (970) |
|Captopril (110) |Trandolapril (2409) |
|Captopril/HCTZ (1378) |Losartan (1971) |
|Enalapril (261) |Candesartan (3297) |
|Enalapril/HCTZ (1687) |Losartan 50mg/HCTZ 12.5mg (3358) |
|Fosinopril (321) |Losartan 100mg/HCTZ 25mg (3359) |
|Lisinopril (428) |Valsartan 80mg/HCTZ 12.5mg (3632) |
|Lisinopril/HCTZ (1254) |Valsartan 160mg/HCTZ 12.5mg (3633) |
|Moexipril (2402) |Eprosartan (3864) |
|Perindopril (3863) |Telmisartan (3865) |
|Quinapril (981) |Olmesartan (3866) |
|Quinapril 10mg/HCTZ 12.5mg (3648) |Valsartan (2187) |
|Quinapril 20mg/HCTZ 12.5mg (3647) |Irbesartan (2934); Hyzaar (1978) |
Yes
No
No
Does Problem List Contain:
Diabetes Mellitus
No
Age > 17 years
No reminder given
Is Rule 1 Active?
No
Blood pressure uncontrolled recommend adding new or increasing dose of current anti-hypertensive
Blood pressure uncontrolled recommend adding new or increasing dose of current anti-hypertensive
Yes
Yes
Is Rule 1? OR 2? Active?
Yes
No
Most recent Creatinine < 3.0
No
Yes
Rule 53:
CHF, HTN, Recommend ACE-I therapy
No
Yes
Serum Creatinine Available?
No
Yes
No
Patient Allergic to Above Meds?
Yes
No
ACE-I or ARB on Med List?
|Benazepril (1067); +Amlodipine (2456) |Quinapril 20mg/HCTZ 25mg (3646) |
|Benazepril/HCTZ (2484) |Ramipril (970) |
|Captopril (110) |Trandolapril (2409) |
|Captopril/HCTZ (1378) |Losartan (1971) |
|Enalapril (261) |Candesartan (3297) |
|Enalapril/HCTZ (1687) |Losartan 50mg/HCTZ 12.5mg (3358) |
|Fosinopril (321) |Losartan 100mg/HCTZ 25mg (3359) |
|Lisinopril (428) |Valsartan 80mg/HCTZ 12.5mg (3632) |
|Lisinopril/HCTZ (1254) |Valsartan 160mg/HCTZ 12.5mg (3633) |
|Moexipril (2402) |Eprosartan (3864) |
|Perindopril (3863) |Telmisartan (3865) |
|Quinapril (981) |Olmesartan (3866) |
|Quinapril 10mg/HCTZ 12.5mg (3648) |Valsartan (2187) |
|Quinapril 20mg/HCTZ 12.5mg (3647) |Irbesartan (2934); Hyzaar (1978) |
Yes
No
SBP < 140 AND DBP < 90?
Yes
Does problem list contain:
Hypertension
OR
Borderline Hypertension
No
BP entered within past 5 years?
Yes
No
Does Problem List Contain:
Congestive Heart Failure
No
Age > 17 years
No reminder given
Yes
Is Rule 1? OR Rule 2? OR Rule 53 Active?
Yes
No reminder given
No
No
Age > 17 years
Yes
No
Does problem list contain:
Hypertension
OR
Borderline Hypertension
No
BP entered within past 5 years?
Yes
Yes
SBP < 130 AND DBP < 80?
No
Yes
Does patient have chronic renal failure?
Requires either Problem List containing any of:
Nephropathy
End Stage Renal Disease
Chronic Renal Dysfunction
Renal Insufficiency
Early Renal Disease
OR
Most Recent Serum Creatinine > 1.5 (in CDR)
No
Blood pressure uncontrolled recommend adding new or increasing dose of current anti-hypertensive
Yes
No
No
Rule 54:
Renal Failure, HTN, Recommend ACE-I therapy
Yes
Cr < 3.0?
Yes
Serum Creatinine Available?
No
Yes
Patient Allergic to Above Meds?
No
ACE-I or ARB on Med List?
|Benazepril (1067) |Quinapril 20mg/HCTZ 25mg (3646) |
|Benazepril/HCTZ (2484) |Ramipril (970) |
|Captopril (110) |Trandolapril (2409) |
|Captopril/HCTZ (1378) |Losartan (1971) |
|Enalapril (261) |Candesartan (3297) |
|Enalapril/HCTZ (1687) |Losartan 50mg/HCTZ 12.5mg (3358) |
|Fosinopril (321) |Losartan 100mg/HCTZ 25mg (3359) |
|Lisinopril (428) |Valsartan 80mg/HCTZ 12.5mg (3632) |
|Lisinopril/HCTZ (1254) |Valsartan 160mg/HCTZ 12.5mg (3633) |
|Moexipril (2402) |Eprosartan (3864) |
|Perindopril (3863) |Telmisartan (3865) |
|Quinapril (981) |Olmesartan (3866) |
|Quinapril 10mg/HCTZ 12.5mg (3648) |Valsartan (2187) |
|Quinapril 20mg/HCTZ 12.5mg (3647) |Irbesartan (2934) |
Yes
No
Rule 54:
Renal Failure, HTN, recommend ACE-I therapy
No
Yes
Patient Allergic to Above Meds?
No
Blood pressure uncontrolled recommend adding new or increasing dose of current anti-hypertensive
Yes
Yes
No
No
Rule 55:
Uncontrolled HTN, recommend diuretic
No
No
Patient Allergic to Above Meds?
No
Yes
No
SBP < 140 AND DBP < 90?
Does problem list contain:
Hypertension
OR
Borderline Hypertension
Yes
Yes
Is Rule 1? OR Rule 2? OR Rule 53 OR Rule 54 Active?
No
BP entered within past 5 years?
No
Age > 17 years?
Yes
No reminder given
Diuretic on Med List?
|Hydrochlorothiazide (353) |Valsartan 160mg/HCTZ 12.5mg (3633) |
|Amiloride (961) |Atenolol 50mg/Chlorthal 25mg (1700) |
|Amiloride/HCTZ (3437) |Atenolol 100mg/Chlorthal 25mg (1699) |
|Spironolactone (711) |Bisoprolol 2.5 mg/HCTZ (1207) |
|Spironolactone/HCTZ 25/25 (26) |Bisoprolol 5mg/HCTZ (1206) |
|Spironolactone/HCTZ 50/50 (2986) |Bisoprolol 10mg/HCTZ (1209) |
|Triamterene (763) |Bisoprolol Fum/HCTZ (1205) |
|Triamterene/HCTZ 37.5/25 (3445) |Nadolol/Bendroflumethiazide 40/5 (1837) |
|Triamterene/HCTZ 50/25 (3446) |Nadolol/Bendroflumethiazide 80/5 (1838) |
|Triamterene/HCTZ (Maxzide-25) (3655) |Propranolol 40/HCTZ 25 (2451) |
|Triamterene/HCTZ (Maxzide) (448) |Propranolol 80/HCTZ 25 (2452) |
|Triamterene/HCTZ (Dyazide) (259) |Timilol/HCTZ (2203) |
|Chlorothiazide (147) | |
|Chlorthalidone (153) | |
|Furosemide (323) | |
|Torsemide (1310) | |
|Bendroflumethiazide (1820) | |
|Trichlormethiazide (2202) | |
|Chlorothiazide 250/Riserpine .125 (2231) | |
|Chlorthalidone 500/Reserpine .125 (2255) | |
|Methychlothiazide (2270) | |
|Benzapril/HCTZ (1067) | |
|Captopril/HCTZ (1378) | |
|Enalapril/HCTZ (1687) | |
|Lisinopril/HCTZ (1254) | |
|Quinapril 10mg/HCTZ 12.5mg (3648) | |
|Quinapril 20mg/HCTZ 12.5mg (3647) | |
|Quinapril 20mg/HCTZ 25mg (3646) | |
|Losartan 50mg/HCTZ 12.5mg (3358) | |
|Losartan 100mg/HCTZ 25mg (3359) | |
|Valsartan 80mg/HCTZ 12.5mg (3632) | |
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