Hypertension: Evaluation

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HYPERTENSION EVALUATION
CLASSIFICATION OF BLOOD PRESSURE (BP)
Category Systolic BP mmHg
Diastolic BP mmHg
Normal <120 AND <80
Prehypertension 120−139 OR 80−89
Hypertension, Stage 1 140−159 OR 90−99
Hypertension, Stage 2 ≥160 OR ≥100
DIAGNOSTIC WORKUP OF HYPERTENSION

• Assess risk factors and comorbidities

• Reveal identifiable causes of hypertension

• Assess presence of target organ damage

• Conduct history and physical examination

• Do ECG

• Obtain laboratory tests: urinalysis, blood glucose, hematocrit and lipid panel, serum potassium, creatinine, and calcium

 Optional: urinary albumin/creatinine ratio

ASSESS FOR MAJOR CARDIOVASCULAR DISEASE (CVD) RISK FACTORS

• Hypertension

• Obesity (body mass index ≥30kg/m²)

• Dyslipidemia

• Diabetes mellitus

• Cigarette smoking

• Physical inactivity

• Microalbuminuria, estimated GFR <60mL/min

• Age (>55 for men, >65 for women)

• Family history of premature CVD (men age <55, women age >65)

ASSESS FOR IDENTIFIABLE CAUSES OF HYPERTENSION

• Sleep apnea

• Drug induced/related

• Chronic kidney disease

• Primary aldosteronism

• Renovascular disease

• Cushing's syndrome or steroid therapy

• Pheochromocytoma

• Coarctation of aorta

• Thyroid/parathyroid disease

BLOOD PRESSURE MEASUREMENT TECHNIQUES
Method Notes
In-office Two readings, 5min apart, sitting in chair. Confirm elevated reading in other arm.
Ambulatory BP
monitoring
Indicated for evaluation of “white coat hypertension.” Absence of 10−20% BP decrease during sleep may indicate increased CVD risk.
Patient
self-check
Provides information on response to therapy. May help improve adherence to therapy and is useful for evaluating “white coat hypertension.”
LIFESTYLE MODIFICATIONS
Modification Recommendation Approximate
SBP Reduction
Physical activity Perform regular aerobic activity (eg, brisk walking) for at least 30min/day most days of the week 4−9mmHg
Weight
management
Maintain normal body weight (BMI 18.5–24.9kg/m²) 5−20mmHg/10kg
weight loss
DASH diet
(Dietary
Approaches
to Stop
Hypertension)
Adopt a diet rich in fruits, vegetables, and low fat dairy products with reduced content of saturated and total fat 8−14mmHg
Reduce sodium
consumption
Reduce dietary sodium intake to max 2.4g sodium or 6g sodium chloride 2−8mmHg
Limit alcohol
consumption
Limit to no more than 2 drinks/day in men and 1 drink/day in women and lighter weight individuals; 1oz or 30mL ethanol; 24oz beer, 10oz wine, or 3oz 80‑proof whiskey 2−4mmHg
REFERENCES

Adapted from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) 5/03 (NIH Publication No. 03‑5231).

(Rev. 7/2015)

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