Evaluation of Hypertension
| EVALUATION OF HYPERTENSION* | |||
|---|---|---|---|
| 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 |
| See Blood Pressure Measurement Techniques (below). | |||
| 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. |
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| ASSESS FOR MAJOR CARDIOVASCULAR DISEASE (CVD) RISK FACTORS | |||
| • Hypertension
• Obesity (body mass index ≥30 kg/m²) • Dyslipidemia • Diabetes mellitus • Cigarette smoking |
• Physical inactivity
• Microalbuminuria, estimated GFR <60 mL/min • Age (>55 for men, >65 for women) • Family history of premature CVD (men age <55, women age >65) |
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| 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 |
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| BLOOD PRESSURE MEASUREMENT TECHNIQUES | |||
| Method | Notes | ||
| In-office | Two readings, 5 minutes 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.” | ||
| NOTES | |||
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* For Adults age 18 years and older. 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. 2/2013) |
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Refer to Treatment of Hypertension chart also located in this section.
