| HYPERTENSION EVALUATION | |||
|---|---|---|---|
| CLASSIFICATION OF BLOOD PRESSURE | |||
| Category | Systolic BP (mmHg) | Diastolic BP (mmHg) | |
| Normal | <120 | AND | <80 |
| Elevated | 120−129 | AND | <80 |
| Hypertension, Stage 1 | 130−139 | OR | 80−89 |
| Hypertension, Stage 2 | ≥140 | OR | ≥90 |
| DIAGNOSTIC WORKUP OF HYPERTENSION | |||
|
• Assess for identifiable causes of hypertension • Assess for CVD risk factors and comorbidities • Evaluate for presence of target organ damage Continue Reading • Conduct history and physical examination |
• Obtain laboratory tests: blood glucose, CBC, lipid profile, serum sodium, potassium, calcium, creatinine, TSH, urinalysis • Perform ECG • Optional: urinary albumin/creatinine ratio, uric acid, echocardiogram |
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| CAUSES OF HYPERTENSION | |||
|
• Genetic predisposition • Overweight/obesity • Excess sodium intake • Insufficient potassium intake • Poor diet • Physical inactivity • Excess alcohol consumption • Drug-induced — Amphetamines, decongestants, caffeine — Antidepressants, atypical antipsychotics — Immunosuppressants — Oral contraceptives — NSAIDs, systemic corticosteroids — Angiogenesis inhibitors, tyrosine kinase inhibitors — Herbal supplements — Recreational drugs |
• Secondary to disorders — Kidney disease — Renal artery stenosis — Primary aldosteronism or other mineralocorticoid excess syndromes — Obstructive sleep apnea — Pheochromocytoma/paraganglioma — Cushing’s syndrome — Hypo- or hyperthyroidism — Aortic coarctation — Primary hyperparathyroidism — Congenital adrenal hyperplasia — Acromegaly |
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| CARDIOVASCULAR DISEASE (CVD) RISK FACTORS | |||
| Modifiable risk factors: | Relatively-fixed risk factors: | ||
|
• Cigarette smoking • Diabetes mellitus • Dyslipidemia/ hypercholesterolemia • Overweight/obesity • Physical inactivity • Unhealthy diet |
• Chronic kidney disease (CKD) • Family history • Increased age • Low socioeconomic/educational status • Male sex • Obstructive apnea • Psychosocial stress |
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| BLOOD PRESSURE MEASUREMENT | |||
| Method | Notes | ||
| In-office | A single reading is inadequate for clinical decision-making. Use an average of ≥2 BP readings obtained on ≥2 separate occasions. Potential for “white coat hypertension” and “masked hypertension.” | ||
| Ambulatory BP monitoring (ABPM) |
Often used to supplement in-office readings. Monitors obtain BP readings at set intervals, usually over a 24-hr period (while patient performs normal daily activities). Has shown to provide better method to predict long-term CVD outcomes than in-office BPs. | ||
| Home BP monitoring (HBPM) | Regular self-monitoring by a patient at home or outside clinical setting. Need to verify use of automated validated devices. Use an average of BP readings on ≥2 occasions for clinical decision-making. | ||
| CAUSES OF RESISTANT HYPERTENSION* | |||
|
• Inaccurate in-office BP measurements • “White coat hypertension” • Obesity • Physical inactivity • Excessive sodium or alcohol intake • Secondary causes of hypertension |
• Medication — Nonadherence — Drug-induced (eg, NSAIDs, stimulants, sympathomimetics, oral contraceptives) — Over-the-counter drugs and herbal supplements (eg, licorice, ephedra) |
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| NOTES | |||
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Key: CBC = complete blood count; ECG = electrocardiogram; TSH = thyroid-stimulating hormone *Defined as persistent hypertension despite therapy with 3 antihypertensive medications with complementary mechanisms of action, or controlled hypertension requiring 4 or more antihypertensive medications. |
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| REFERENCES | |||
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James PA, Oparil S, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427. (Rev. 7/2020) |
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This article originally appeared on MPR
