Hypertension
Classification of blood pressure for adults
nBlood Pressure SBP DBP
nNormal <120 and <80
nPrehypertension 120–139 or 80–89
nStage 1 Hypertension 140–159 or 90–99
nStage 2 Hypertension >160 or >100
Recommendations for followup based on initial blood pressure
For adults without acute end organ damage
Initial Blood Pressure Follow up Recommended
nNormal Recheck in 2 years
nPrehypertension Recheck in 1 year
nStage 1 Hypertension Confirm within 2 months
nStage 2 Hypertension Evaluate or refer to source of care within 1 month. with higher pressures (e.g.,>180/110 mmHg), evaluate and treat immediately or within 1 week depending on clinical situation and complications.
Clinical situations in which ambulatory blood pressure monitoring may be helpful
nSuspected white-coat hypertension in patients with hypertension and no target organ damage
nApparent drug resistance (office resistance)
nHypotensive symptoms with antihypertensive medication
nEpisodic hypertension
nAutonomic dysfunction
Target Organ Damage
nHeart
nLVH
nAngina/prior MI Prior coronary revascularization
nHeart failure
nBrain
nStroke or transient ischemic attack
nDementia
nCKD
nPeripheral arterial disease
nRetinopathy
Benefits of Lowering Blood Pressure
nIn clinical trials, antihypertensive therapy has been associated with reductions in
n(1) stroke incidence, averaging 35–40 percent;
n(2) myocardial infarction (MI), averaging 20–25 percent; and
n(3) HF, averaging >50 percent
Diagnostic Workup of Hypertension
nAssess risk factors and comorbidities.
nReveal identifiable causes of hypertension.
nAssess presence of target organ damage.
nConduct history and physical examination.
nObtain laboratory tests: urinalysis, blood glucose, hematocrit and lipid panel, serum potassium, creatinine, and calcium. Optional: urinary albumin/creatinine ratio.
nObtain electrocardiogram.
Assess for Major Cardiovascular Disease (CVD) Risk Factors
nHypertension
nObesity (body mass index >30 kg/m2)
nDyslipidemia
nDiabetes mellitus
nCigarette smoking
nPhysical inactivity
nMicroalbuminuria, estimated
nglomerular filtration rate <60 mL/min
nAge (>55 for men, >65 for women)
nFamily history of premature CVD (men age <55, women age <65)
Assess for Identifiable Causes of Hypertension
nChronic kidney disease
nDrug induced/related
nRenovascular disease
nPrimary aldosteronism
nCushing’s syndrome or steroid therapy
nPheochromocytoma
nCoarctation of aorta
nSleep apnea
nThyroid/parathyroid disease
Principles of Hypertension Treatment
nTreat to BP <140/90 mmHg or BP <130/80 mmHg in patients with diabetes or chronic kidney disease.
nMajority of patients will require two medications to reach goal.
Lifestyle modifications to prevent and manage hypertension
nWeight reduction
nMaintain normal body weight (body mass index 18.5–24.9 kg/m2).
n5–20 mmHg/10kg
nAdopt DASH eating plan
nConsume a diet rich in fruits, vegetables, and lowfat dairy products with a reduced content of saturated and total fat.
n8–14 mmHg
nDietary sodium reduction
nReduce dietary sodium intake to no more than 100 mmol per day (2.4 g sodium or 6 g sodium chloride).
n2–8 mmHg
nPhysical activity
nEngage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week).
n4–9 mmHg
nModeration of alcohol consumption
nLimit consumption to no more than 2 drinks (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men, and to no more than 1 drink per day in women and lighter weight persons.
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