/** Arezzo Guideline: Hypertension **/

/** 12/02/2001, 18:14:53 **/ 

plan :: Hypertension ;
   caption :: 'Hypertension' ;
   component :: Current_therapy ;
   component :: Comorbidities ;
   component :: Additional_drug_choice ;
      schedule_constraint :: completed(Current_therapy) ;
      schedule_constraint :: completed(Comorbidities) ;
   component :: Target_BP_decision ;
      autonomous :: yes ;
      schedule_constraint :: completed(Comorbidities) ;
   component :: Prescribe_additional_drug ;
      schedule_constraint :: completed(Additional_drug_choice) ;
      schedule_constraint :: completed(Target_BP_decision) ;
   component :: Assess_response ;
      schedule_constraint :: completed(Prescribe_additional_drug) ;
      number_of_cycles :: -1 ;
end plan . 

decision :: Additional_drug_choice ;
   caption :: 'Additional drug choice' ;
   choice_mode :: single ;
   support_mode :: symbolic ;
   candidate :: ACEI ;
      argument :: excluding, ( Current_Rx = ACEI ) ;
      argument :: excluding, ( Pregnancy = Yes ) ;
      argument :: confirming, ( Heart_failure = Yes ) ;
      argument :: confirming, ( MI = Yes and Systolic_dysfunction = Yes ) ;
      argument :: excluding, ( Current_Rx = K_sparing_diuretic ) ;
      argument :: confirming, ( Type_1_Diabetes = Yes and Proteinuria <> None ) ;
      recommendation :: Netsupport( Additional_drug_choice, ACEI ) >= 1 ;
   candidate :: ISA_beta_blocker ;
      argument :: excluding, ( Asthma = Yes or COPD = Yes ) ;
      argument :: excluding, ( STD_Heart_block = Yes ) ;
      argument :: excluding, ( Current_Rx = Ca_blocker_non_DHP ) ;
      argument :: for, ( Current_Rx = Thiazide_diuretic ) ;
      argument :: for, ( Current_Rx = Ca_blocker_DHP_long or Current_Rx = Ca_blocker_DHP_short ) ;
      argument :: excluding, ( Current_Rx = Beta_blocker_ISA or Current_Rx = Beta_blocker_non_ISA ) ;
      argument :: against, ( Type_1_Diabetes = Yes and Proteinuria <> None ) ;
      recommendation :: Netsupport( Additional_drug_choice, ISA_beta_blocker ) >= 1 ;
   candidate :: Non_ISA_beta_blocker ;
      argument :: excluding, ( Asthma = Yes or COPD = Yes ) ;
      argument :: excluding, ( STD_Heart_block = Yes ) ;
      argument :: confirming, ( MI = Yes ) ;
      argument :: excluding, ( Current_Rx = Ca_blocker_non_DHP ) ;
      argument :: for, ( Current_Rx = Thiazide_diuretic ) ;
      argument :: for, ( Current_Rx = Ca_blocker_DHP_long or Current_Rx = Ca_blocker_DHP_short ) ;
      argument :: excluding, ( Current_Rx = Beta_blocker_non_ISA or Current_Rx = Beta_blocker_ISA ) ;
      argument :: against, ( Type_1_Diabetes = Yes and Proteinuria <> None ) ;
      recommendation :: Netsupport( Additional_drug_choice, Non_ISA_beta_blocker ) >= 1 ;
   candidate :: Ca_channel_dihydro_long ;
      argument :: confirming, ( Isolated_Sys_hypertension = Yes and Age_group = Older ) ;
      argument :: excluding, ( Current_Rx = Ca_blocker_non_DHP ) ;
      argument :: for, ( Current_Rx = Beta_blocker_ISA or Current_Rx = Beta_blocker_non_ISA ) ;
      argument :: excluding, ( Current_Rx = Ca_blocker_DHP_long or Current_Rx = Ca_blocker_DHP_short or Current_Rx = Ca_blocker_non_DHP ) ;
      argument :: for, ( Type_1_Diabetes = Yes and Proteinuria <> None ) ;
      recommendation :: Netsupport( Additional_drug_choice, Ca_channel_dihydro_long ) >= 1 ;
   candidate :: Ca_channel_non_dihydro ;
      argument :: excluding, ( STD_Heart_block = Yes ) ;
      argument :: excluding, ( Current_Rx = Beta_blocker_ISA or Current_Rx = Beta_blocker_non_ISA ) ;
      argument :: excluding, ( Current_Rx = Ca_blocker_DHP_long or Current_Rx = Ca_blocker_DHP_short ) ;
      argument :: excluding, ( Current_Rx = Ca_blocker_DHP_long or Current_Rx = Ca_blocker_DHP_short or Current_Rx = Ca_blocker_non_DHP ) ;
      argument :: for, ( Type_1_Diabetes = Yes and Proteinuria <> None ) ;
      recommendation :: Netsupport( Additional_drug_choice, Ca_channel_non_dihydro ) >= 1 ;
   candidate :: Thiazide_diuretic ;
      argument :: confirming, ( Isolated_Sys_hypertension = Yes and Age_group = Older ) ;
      argument :: for, ( Current_Rx = Beta_blocker_ISA or Current_Rx = Beta_blocker_non_ISA ) ;
      argument :: excluding, ( Current_Rx = Thiazide_diuretic or Current_Rx = K_sparing_diuretic or Current_Rx = Loop_diuretic ) ;
      recommendation :: Netsupport( Additional_drug_choice, Thiazide_diuretic ) >= 1 ;
   candidate :: Loop_diuretic ;
      argument :: confirming, ( Heart_failure = Yes ) ;
      argument :: confirming, ( Isolated_Sys_hypertension = Yes and Age_group = Older ) ;
      argument :: excluding, ( Current_Rx = Thiazide_diuretic or Current_Rx = K_sparing_diuretic or Current_Rx = Loop_diuretic ) ;
      recommendation :: Netsupport( Additional_drug_choice, Loop_diuretic ) >= 1 ;
   candidate :: K_sparing_diuretic ;
      argument :: confirming, ( Isolated_Sys_hypertension = Yes and Age_group = Older ) ;
      argument :: excluding, ( Current_Rx = ACEI ) ;
      argument :: excluding, ( Current_Rx = Thiazide_diuretic or Current_Rx = K_sparing_diuretic or Current_Rx = Loop_diuretic ) ;
      recommendation :: Netsupport( Additional_drug_choice, K_sparing_diuretic ) >= 1 ;
   candidate :: Ca_channel_dihydro_short ;
      argument :: confirming, ( Isolated_Sys_hypertension = Yes and Age_group = Older ) ;
      argument :: excluding, ( Current_Rx = Ca_blocker_non_DHP ) ;
      argument :: for, ( Current_Rx = Beta_blocker_ISA or Current_Rx = Beta_blocker_non_ISA ) ;
      argument :: excluding, ( Current_Rx = Ca_blocker_DHP_long or Current_Rx = Ca_blocker_DHP_short or Current_Rx = Ca_blocker_non_DHP ) ;
      argument :: for, ( Type_1_Diabetes = Yes and Proteinuria <> None ) ;
      recommendation :: Netsupport( Additional_drug_choice, Ca_channel_dihydro_short ) >= 1 ;
end decision . 

plan :: Assess_response ;
   caption :: 'Assess response' ;
   goal :: DBP < targetDBP and SBP < targetSBP ;
   component :: Monitor_BP ;
   component :: Await_adequate_response ;
end plan . 

action :: Await_adequate_response ;
   caption :: 'Await adequate response' ;
   procedure :: 'Continue therapy until target BPs reached' ;
end action . 

enquiry :: Comorbidities ;
   source :: Proteinuria ;
      mandatory :: yes ;
   source :: Heart_failure ;
      mandatory :: yes ;
   source :: Isolated_Sys_hypertension ;
      mandatory :: yes ;
   source :: Age_group ;
      mandatory :: yes ;
   source :: MI ;
      mandatory :: yes ;
   source :: Systolic_dysfunction ;
      mandatory :: yes ;
   source :: Asthma ;
      mandatory :: yes ;
   source :: COPD ;
      mandatory :: yes ;
   source :: Pregnancy ;
      mandatory :: yes ;
   source :: Type_1_Diabetes ;
      mandatory :: no ;
   source :: STD_Heart_block ;
      mandatory :: no ;
end enquiry . 

enquiry :: Current_therapy ;
   caption :: 'Current therapy' ;
   source :: Current_Rx ;
      mandatory :: yes ;
end enquiry . 

enquiry :: Monitor_BP ;
   caption :: 'Monitor BP' ;
   source :: SBP ;
      mandatory :: yes ;
   source :: DBP ;
      mandatory :: yes ;
end enquiry . 

action :: Prescribe_additional_drug ;
   caption :: 'Prescribe additional drug' ;
   procedure :: 'Prescribe additional drug as chosen.' ;
end action . 

decision :: Target_BP_decision ;
   caption :: 'Target BP decision' ;
   postcondition :: TargetSBP = if( result_of( Target_BP_decision) = Standard, 140, if( result_of( Target_BP_decision) = Medium, 130, 125)) and TargetDBP = if( result_of( Target_BP_decision) = Standard, 90, if( result_of( Target_BP_decision) = Medium, 85, 75)) ;
   choice_mode :: single ;
   support_mode :: symbolic ;
   candidate :: Standard ;
      argument :: for, ( Proteinuria = None and Type_1_Diabetes = No ) ;
      recommendation :: Netsupport( Target_BP_decision, Standard ) >= 1 ;
   candidate :: Medium ;
      argument :: for, ( Type_1_Diabetes = Yes or Proteinuria = '<1 g / 24 hrs' ) ;
      recommendation :: Netsupport( Target_BP_decision, Medium ) >= 1 ;
   candidate :: Low ;
      argument :: confirming, ( Proteinuria = '>1 g / 24 hrs' ) ;
      recommendation :: Netsupport( Target_BP_decision, Low ) >= 1 ;
end decision . 

data :: Age_group ;
   type :: text ;
   caption :: 'Patients age group' ;
   range :: Younger, Older ;
end data . 

data :: Asthma ;
   type :: boolean ;
   caption :: 'Does the patient have asthma?' ;
   true_value :: Yes ;
   false_value :: No ;
end data . 

data :: COPD ;
   type :: boolean ;
   caption :: 'Does that patient have COPD?' ;
   true_value :: Yes ;
   false_value :: No ;
end data . 

data :: Current_Rx ;
   type :: text ;
   caption :: 'Patients current therapy' ;
   range :: ACEI, Beta_blocker_ISA, Beta_blocker_non_ISA, Ca_blocker_DHP_long, Ca_blocker_DHP_short, Ca_blocker_non_DHP, Thiazide_diuretic, Loop_diuretic, K_sparing_diuretic ;
end data . 

data :: DBP ;
   type :: integer ;
   caption :: 'Diastolic BP' ;
end data . 

data :: Heart_failure ;
   type :: boolean ;
   caption :: 'Does the patient have heart failure?' ;
   true_value :: Yes ;
   false_value :: No ;
end data . 

data :: Isolated_Sys_hypertension ;
   type :: boolean ;
   caption :: 'Isolated systolic hypertension?' ;
   true_value :: Yes ;
   false_value :: No ;
end data . 

data :: MI ;
   type :: boolean ;
   caption :: 'Previous MI?' ;
   true_value :: Yes ;
   false_value :: No ;
end data . 

data :: Pregnancy ;
   type :: boolean ;
   caption :: 'Is the patient pregnant?' ;
   true_value :: Yes ;
   false_value :: No ;
end data . 

data :: Proteinuria ;
   type :: text ;
   caption :: 'Proteinuria?' ;
   range :: None, '<1 g / 24 hrs', '>1 g / 24 hrs' ;
end data . 

data :: SBP ;
   type :: integer ;
   caption :: 'Systolic BP' ;
end data . 

data :: STD_Heart_block ;
   type :: boolean ;
   caption :: 'Second or third degree heart block' ;
   true_value :: Yes ;
   false_value :: No ;
end data . 

data :: Systolic_dysfunction ;
   type :: boolean ;
   caption :: 'Systolic dysfunction' ;
   true_value :: Yes ;
   false_value :: No ;
end data . 

data :: targetDBP ;
   type :: integer ;
end data . 

data :: targetSBP ;
   type :: integer ;
end data . 

data :: Type_1_Diabetes ;
   type :: boolean ;
   caption :: 'Type 1 diabetes?' ;
   true_value :: Yes ;
   false_value :: No ;
end data .