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)

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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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