What is the threshold for initiation in low risk patients? Hypertension Canada says SBP above 160 or DBP above 100.
Response: That is for the first set of readings, in clinic. If BP does not come under control in 2-3 months it is recommended to start therapy if BP is 140-159/90-99 if health messures changes is not bringing it under contro alonel.

Can you repeat the proper way of doing home BP monitoring? Is it 4 times a day for 1 week ?
Response: Twice daily. Each measure should be repeated after 1 minute, giving 4 daily.

There seems to be a relationship between uncontrolled hypertension and orthostatic hypotension. Should we be more agressive in the treatment of uncontrolled hypertension for frail elderly that have orthostasis?
Response: Less agressive for frail elderly with orthostatic drops in BP. But the frail elderly without orthostasis, actually have a greater absolute benefit from targeting BP < 120 systolic due to their higher CV risk.

For automated office blood pressure, if it is not possible to do multiple readings or have the patient in a separate room, would we use 140/90 as our cutoff (like a manual reading)?
Response: If the BP is done in a quiet place in the waiting room. A mean of three readings for example, that is acceptable as automated office BP.

What about diastolic hypertension with an normal systolic? Any specific agents to use?
Response: Diastolic hypertension is typically seen in young healthy men, who have a more dynamic circulation. I like to look for LVH with an echo, and if it is present, that is an indication for using more meds if needed to achieve targets. Consider a long acting CCB like amlodipine and adding a long acting beta blocker if tolerated.

When it comes to ABPM, if the average total BP is normal but the average daytime measurements are high, is this sufficient to diagnose hypertension?
Response: If either the daytime or 24 hour ABPM are high, that is hypertension

For the non dippers on 24 hrs monitor, do you change Rx chronology ?
Response: They are at higher CV risk, so more aggressive global CV risk management