Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
Key Points
Key Points
- Observational studies have demonstrated graded associations between higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) and increased CVD risk.
- A large meta-analysis found a 20 mm Hg higher SBP and 10 mm Hg higher DBP were each prospectively associated with a doubling in the risk of death from stroke, heart disease, or other vascular disease. In a separate observational study including >1 million adult patients ≥30 years of age, higher SBP and DBP were associated with increased risk of CVD incidence and angina, myocardial infarction (MI), heart failure (HF), stroke, peripheral artery disease (PAD), abdominal aortic aneurysm, and chronic renal disease (CKD).
- This increased risk has been reported across a broad age spectrum, from 30 years to >80 years of age.
- CVD risk factors frequently occur in combination, with ≥3 risk factors present in 17% of patients. Lifetime risk of CVD death, nonfatal MI, and fatal or nonfatal stroke is substantially higher in adults with ≥2 CVD risk factors than in those with only 1 risk factor.
- Treating modifiable risk factors may reduce blood pressure (BP) through modification of shared pathology, and CVD risk may be reduced by treating global risk factor burden.
Diagnosis
...gnosis
...sk Factors Common in Patients With Hyperte...
...2. Environmental Risk FactorsHavin...
...Hypertension and Related Chronic Conditions...
...for and management of other modifiable...
...tion of High BP...
BP should be categorized as normal, elevated, or...
...3. Categories of BP in AdultsaHaving trouble vi...
...Measurement of BP in the Office...
...nosis and management of high BP, prop...
.... Checklist for Accurate Measurement of BPHa...
...ion Criteria for BP Cuff Size for Measurement...
...ut-of-Office and Self-Moni...
...ce BP measurements are recommended to...
...Procedures for Use of HBPMHaving trouble viewing...
...responding Values of SBP/DBP for Clinic, H...
...and White Coat Hypertension...
...s with an untreated SBP greater than 130 mm Hg but...
...s with white coat hypertension, periodic monitor...
...being treated for hypertension with office BP...
...n adults with untreated office BPs tha...
...on multiple-drug therapies for hypertensi...
...easonable to screen for masked uncontrolled...
In adults being treated for hypert...
Figure 1. Detection of White Coat Hyper...
...P Patterns Based on Office and Out-o...
...etection of White Coat Effect or M...
...s for Secondary Forms of Hypertens...
...or specific form(s) of secondary hypert...
...adult with sustained hypertension screens p...
...Screening for Secondary Hypertension
...able 9. Causes of Secondary Hypertension W...
...able 10. Frequently Used Medications an...
Primary Aldoster...
...adults with hypertension, screening for primar...
...lasma aldosterone: Renin activity rat...
...ith hypertension and a positive screening tes...
...enal Artery Stenosis
...edical therapy is recommended for adult...
...enal artery stenosis for whom medical managem...
...ctive Sleep Apnea...
...hypertension and obstructive sleep apnea, the...
Patient Evaluation
...tient Evaluation...
...1. Historical Features Favoring Hypertension Cau...
...ble 12. Basic and Optional Laboratory Tests f...
Treatment and Pharmacological Treatment
...atment and Pharmacological Tre...
...rmacological Intervent...
...loss is recommended to reduce BP in adults wit...
...ealthy diet, such as the DASH (Dietary Approa...
...uction is recommended for adults with...
...sium supplementation, preferably in...
...ased physical activity with a struct...
...men with elevated BPa or hypertension who...
...roven Nonpharmacological Interventions...
...eatment Threshold and the Use of CVD Risk E...
...BP (I, A)573...
...BP (I, C-EO)573...
...se of BP-lowering medication is reco...
...Goal for Patients With Hype...
...I, B-R)(SR)573...
...I, C-EO)573
...BP (IIb, B-N...
...(IIb, C-EO)573...
...oice of Initial Medication
...or initiation of antihypertensive drug the...
...on of antihypertensive drug therapy with 2 first-l...
...ion of antihypertensive drug therapy...
...llow-Up After Initiating Antihypertensive Drug Th...
...dults initiating a new or adjusted drug regime...
...rategies to Improve Control of BP in Patients on D...
...w-up and monitoring after initiation of drug...
...Principle of Drug Therapy...
...aneous use of an ACE inhibitor, ARB, and/or re...
...BP Thresholds and Recommendations for Treatment...
...-Up After Initial BP Evaluat...
...th an elevated BP or stage 1 hypertension w...
...ge 1 hypertension who have an estimated...
...h stage 2 hypertension should be evalua...
...s with a very high average BP (e.g.,...
...a normal BP, repeat evaluation every year is...
...14. Oral Antihypertensive DrugsHaving trouble vi...
Hypertension in Patients With Comorbidities
...rtension in Patients With Comorbi...
Stable Ischemic Hear...
...BP (I, B-R...
...(I, C-EO)573...
...(I, B-R)573
...P (I, C-EO)...
...h SIHD with angina and persistent uncont...
...s who have had a MI or acute coronary synd...
...d/or CCBs might be considered to control hyp...
Figure 5. Management of Hypertension in Patient...
...art Failu...
...BP (I, B-R)...
...I, C-EO)573...
...th Reduced Ejection Fraction (HFrEF)...
...ults with HFrEF and hypertension shoul...
...ondihydropyridine CCBs are NOT recommended in...
...re With Preserved Ejection Fraction (HFpEF...
...h HFpEF who present with symptoms o...
...lts with HFpEF and persistent hypertension after...
...Kidney Disease...
...P (I, B-R)(SR)...
...I, C-EO)573...
...hypertension and CKD (stage 3 or higher or stag...
...th hypertension and CKD (stage 3 or highe...
...igure 6. Management of Hypertension in...
...racerebral Hemorrhage (ICH)...
In adults with ICH who present with SBP gre...
...ing of SBP (Table 14) to less than 140 mm Hg in...
...nagement of Hypertension in Patients with Acute...
...ute Ischemic Stroke (AIS...
...ith AIS and elevated BP who are eligible for t...
...th an AIS, BP should be less than 18...
...restarting antihypertensive therapy dur...
...h BP of 220/120 mm Hg or higher who did no...
...ents with BP less than 220/120 mm Hg...
...agement of Hypertension in Patients With Acute...
...ary Stroke Prevention...
...previously treated hypertension who experience a...
...ho experience a stroke or TIA, treatment with a...
...previously treated for hypertension...
...ults who experience a stroke or TIA, selection of...
...ho experience a stroke or TIA, a BP goal of less...
...a lacunar stroke, a target SBP goa...
...eviously untreated for hypertension...
Figure 9. Management of Hypertensio...
...her Comorbidit...
Hypertension After Renal Transpl...
...(IIa, B-NR)573
...(IIa, C-EO)573...
...ransplantation, it is reasonable to treat...
...heral Artery Disease
...pertension and PAD should be treated similarly...
...abetes Melli...
SBP (I, B-R)(SR)...
...I, C-EO)573...
...n adults with DM and hypertension, all first-line...
...h DM and hypertension, ACE inhibitors or AR...
...al Fibrillation...
...ent of hypertension with an ARB can be usefu...
...lar Heart Disease...
...ults with asymptomatic aortic stenosis...
...ents with chronic aortic insufficiency, treatmen...
...ic Disease
Beta blockers are recommended as the p...
...Ethnic Differences in Treatment...
...lack adults with hypertension but without HF or CK...
...ore antihypertensive medications are recommended...
...egnanc...
...omen with hypertension who become pr...
...rtension who become pregnant should NOT be...
...r Persons...
...ertension with a SBP treatment goa...
...s (≥65 years of age) with hypertension and a hig...
...e Decline and Dementia
...ypertension, BP lowering is reasonable to...
...ients Undergoing Surgical Procedures...
...operative
...n patients with hypertension undergoing m...
In patients with hypertension undergoing...
...h hypertension undergoing major surgery, di...
...th planned elective major surgery and SBP of 1...
...undergoing surgery, abrupt preoperative...
...should NOT be started on the day of...
...traoperative
...ents with intraoperative hypertension should be m...
Resistant Hypertension
...stant Hypertension...
...Resistant Hypertension: Diagnosis, Evaluation, and...
...Crises—Emergencies and Urgencies...
...ults with a hypertensive emergency, admission t...
...a compelling condition (i.e., aortic dissec...
...hout a compelling condition, SBP sho...
...re 11. Diagnosis and Management of...
...venous Antihypertensive Drugs for Treatment o...
...le 16. Intravenous Antihypertensive...
Patients With Hypertension
...With Hypertension...
...ving Quality of Care for Patients With...
...ypertensive Medication Adherence Strateg...
In adults with hypertension, dosing of antihyperte...
...of combination pills rather than free indiv...
...tegies to Promote Lifestyle Modification...
...fective behavioral and motivational...
...eam-Based Care Interventions for Hyperten...
...am-based care approach is recommended fo...
...lectronic Health Record (EHR) and Pa...
...EHR and patient registries is beneficial for i...
...e EHR and patient registries is beneficial for...
...erventions to Improve Hypertension Control...
...ealth strategies can be useful adjuncts to inte...
...erformance Measure...
...e of performance measures in combination with othe...
Quality Improvement Strate...
...e of quality improvement strategies at th...
...ncial Incentives...
...inancial incentives paid to providers can...
...alth system financing strategies (e.g., insurance...
...f Care for Hypertensio...
...th hypertension should have a clear, d...
...ian’s Sequential Flow Chart for the Managemen...
...P Thresholds for and Goals of Pharm...