HYPERTENSION

Hypertension is a major public health problem in developed nations. It is common, asymptomatic, readily detectable, and easily treatable—and it can lead to lethal complications if not treated.

HYPERTENSION

A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first/upper number measures the pressure in your arteries when your heart beats (systolic pressure). The second/lower number measures the pressure in your arteries between beats (diastolic pressure).

Blood pressure measurements fall into four general categories:

  • Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg.
  • Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure.
  • Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.
  • Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.

Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 90 mm Hg) but systolic pressure is high (greater than 140 mm Hg). This is a common type of high blood pressure among people older than 60.

American Diabetes Association Guidelines: Target BP goal for patients with diabetes—≤130/80 mm Hg







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Baseline Laboratory Evaluation

Initial workup

Basic testing for primary hypertension includes fasting blood glucose (FBS) or A1c, complete blood cell count (CBC), lipid profile, basic metabolic panel, thyroid stimulating hormone (TSH), urinalysis, electrocardiogram (ECG) with optional echocardiogram, uric acid, and urinary albumin-to-creatinine ratio. An increase in cardiovascular risk is associated with a decreased GFR level and with albuminuria.

Assessment of suspected secondary causes

Table below, summarizes the Seventh Report of the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) screening tests for specific identifiable causes of hypertension.

Identifiable Hypertension and Screening Tests


Condition Screening Test
Chronic kidney disease Chronic kidney disease
Coarctation of the aorta Computed tomography angiography
Cushing syndrome; other states of glucocorticoid excess (eg, chronic steroid therapy Dexamethasone suppression test
Drug-induced/drug-related hypertension* Drug screening
Pheochromocytoma 24-hour urinary metanephrine and normetanephrine
Primary aldosteronism, other states of mineralocorticoid excess Plasma aldosterone to renin activity ratio (ARR). If abnormal, refer for further evaluation such as saline infusion to determine if aldosterone levels can be suppressed, 24-hour urinary aldosterone level, and specific mineralocorticoid tests
Renovascular hypertension Doppler flow ultrasonography, magnetic resonance angiography, computed tomography angiography
Sleep apnea Sleep study with oxygen saturation (screening would also include the Epworth Sleepiness Scale [ESS])
Thyroid/parathyroid disease Thyroid stimulating hormone level, serum parathyroid hormone level