Evaluation of Hypertension
|EVALUATION OF HYPERTENSION*|
|CLASSIFICATION OF BLOOD PRESSURE (BP)|
|Category||Systolic BP mmHg||
||Diastolic BP mmHg|
|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.
|ASSESS FOR MAJOR CARDIOVASCULAR DISEASE (CVD) RISK FACTORS|
• Obesity (body mass index ≥30 kg/m²)
• 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)
|ASSESS FOR IDENTIFIABLE CAUSES OF HYPERTENSION|
|• Sleep apnea
• Drug induced/related
• Chronic kidney disease
• Primary aldosteronism
• Renovascular disease
|• Cushing's syndrome or steroid therapy
• Coarctation of aorta
• Thyroid/parathyroid disease
|BLOOD PRESSURE MEASUREMENT TECHNIQUES|
|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.”|
* 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).
Refer to Treatment of Hypertension chart also located in this section.