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
...iagnosis
...isk Factors Common in Patients With Hyperte...
...onmental Risk FactorsHaving trouble vie...
Coexistence of Hypertension and Rela...
...and management of other modifiable CVD ris...
...nition of High BP...
...uld be categorized as normal, elevated, or stage...
...le 3. Categories of BP in AdultsaHaving troub...
...asurement of BP in the Office...
...diagnosis and management of high BP...
...Checklist for Accurate Measurement of BPHaving...
...ble 5. Selection Criteria for BP Cuff Siz...
...-Office and Self-Monitoring o...
Out-of-office BP measurements are recommended to...
Table 6. Procedures for Use of HBPMHaving trou...
...7. Corresponding Values of SBP/DBP for...
...d and White Coat Hypertension
...h an untreated SBP greater than 130...
...ts with white coat hypertension, per...
...n adults being treated for hypertension w...
...ults with untreated office BPs that are c...
...adults on multiple-drug therapies for hype...
...asonable to screen for masked uncontroll...
...lts being treated for hypertension with elevated...
...ction of White Coat Hypertension or Masked...
...e 8. BP Patterns Based on Office and Out-of...
...ction of White Coat Effect or Masked Un...
...mmendations for Secondary Forms of Hyperte...
...g for specific form(s) of secondary hyp...
...an adult with sustained hypertens...
...re 3. Screening for Secondary Hy...
...9. Causes of Secondary Hypertension With Clinical...
...ntly Used Medications and Other Substances Tha...
...ry Aldosteronis...
...th hypertension, screening for primary aldostero...
...se of the plasma aldosterone: Renin...
In adults with hypertension and a positiv...
Renal Artery Ste...
...cal therapy is recommended for adults wi...
...n adults with renal artery stenosis for whom medic...
...tructive Sleep A...
...ults with hypertension and obstructive sleep apne...
Patient Evaluation
...nt Evaluation...
.... Historical Features Favoring Hypertens...
...and Optional Laboratory Tests for Primary Hype...
Treatment and Pharmacological Treatment
...ent and Pharmacological Treatme...
...rmacological Interventions...
...is recommended to reduce BP in adults with elevat...
...rt-healthy diet, such as the DASH (Dietary...
...n is recommended for adults with elevated BP...
...supplementation, preferably in dietary mo...
...ased physical activity with a struc...
...ult men and women with elevated BPa or hyperten...
...e 13. Best Proven Nonpharmacological I...
...Treatment Threshold and the Use of CVD Risk...
...BP (I, A)57...
...I, C-EO)573...
...owering medication is recommended f...
...Patients With Hypertension...
...BP (I, B-R)(SR)573
...I, C-EO)573...
SBP (IIb, B-NR)57...
DBP (IIb, C-EO)57...
...e of Initial Medication
...f antihypertensive drug therapy, f...
...ion of antihypertensive drug therapy with 2 fi...
...itiation of antihypertensive drug...
...Initiating Antihypertensive Drug Therapy...
...itiating a new or adjusted drug regimen for hyp...
...toring Strategies to Improve Control of...
...monitoring after initiation of dru...
...ral Principle of Drug Therapy...
...ltaneous use of an ACE inhibitor, ARB, an...
...Thresholds and Recommendations for Treatment...
...p After Initial BP Evaluation...
...s with an elevated BP or stage 1 hypertension...
...with stage 1 hypertension who have an estimated 10...
...ts with stage 2 hypertension should be eval...
...a very high average BP (e.g., SBP ≥180...
...adults with a normal BP, repeat evaluation eve...
...ble 14. Oral Antihypertensive DrugsHaving trouble...
Hypertension in Patients With Comorbidities
...pertension in Patients With Comorbiditie...
Stable Ischemic Heart Dis...
SBP (I, B-R...
...(I, C-EO)573...
SBP (I, B-R)57...
...BP (I, C-EO)5...
...SIHD with angina and persistent uncontr...
...who have had a MI or acute coronary...
...and/or CCBs might be considered to c...
...ment of Hypertension in Patients With SIHD...
...eart Failure
...(I, B-R)573...
...BP (I, C-EO)57...
...th Reduced Ejection Fraction (HFrEF)...
...h HFrEF and hypertension should be prescri...
...ridine CCBs are NOT recommended in t...
...lure With Preserved Ejection Fraction (...
...FpEF who present with symptoms of volume overlo...
...lts with HFpEF and persistent hyperten...
...hronic Kidney D...
..., B-R)(SR)573...
...(I, C-EO)57...
...ith hypertension and CKD (stage 3...
...adults with hypertension and CKD (stage...
...6. Management of Hypertension in Pa...
...racerebral Hemorrhage (ICH)...
...ICH who present with SBP greater than 220...
...lowering of SBP (Table 14) to less than 140 mm Hg...
...Management of Hypertension in Patients...
...te Ischemic Stroke (AIS)...
...ts with AIS and elevated BP who are elig...
...th an AIS, BP should be less than 185...
...arting antihypertensive therapy during hos...
...ents with BP of 220/120 mm Hg or higher w...
...atients with BP less than 220/120 mm Hg who did n...
...gement of Hypertension in Patients With Acut...
...dary Stroke Prevention...
...with previously treated hypertensio...
...r adults who experience a stroke or TIA, tr...
...not previously treated for hypertensio...
...who experience a stroke or TIA, selection...
...ho experience a stroke or TIA, a BP go...
...adults with a lacunar stroke, a target SBP...
...usly untreated for hypertension who experie...
...agement of Hypertension in Patients With a Pr...
...er Comorbidities...
...tension After Renal Transplantation...
...Ia, B-NR)573...
...Ia, C-EO)573...
...ey transplantation, it is reasonable...
Peripheral Artery Di...
...s with hypertension and PAD should be treat...
...etes Mellitus...
...P (I, B-R)(SR)57...
...I, C-EO)573
...th DM and hypertension, all first-line classes of...
...ults with DM and hypertension, ACE inhibitors...
...rial Fibrillati...
...reatment of hypertension with an ARB c...
...ar Heart Disease...
...ults with asymptomatic aortic stenosis...
...patients with chronic aortic insufficiency, treatm...
Aortic Diseas...
...ers are recommended as the preferred antihyperte...
...al and Ethnic Differences in Treatment...
...with hypertension but without HF o...
...re antihypertensive medications are recommended...
...gnancy...
...hypertension who become pregnant, or a...
...tension who become pregnant should NO...
...lder Perso...
...hypertension with a SBP treatment goal of less...
...er adults (≥65 years of age) wit...
...gnitive Decline and Dement...
...th hypertension, BP lowering is reasonable...
...ents Undergoing Surgical Procedur...
Preoperative
...n patients with hypertension undergoi...
...atients with hypertension undergoing plann...
...ith hypertension undergoing major surgery,...
...ts with planned elective major sur...
...patients undergoing surgery, abrupt preoperati...
...ers should NOT be started on the day of...
...traoperative
...nts with intraoperative hypertension should be...
Resistant Hypertension
...tant Hypertension
...Resistant Hypertension: Diagnosis, Evaluati...
...sive Crises—Emergencies and Urgencies...
...a hypertensive emergency, admission to an inten...
...ith a compelling condition (i.e., aortic dissecti...
...without a compelling condition, SBP shoul...
Figure 11. Diagnosis and Management of a Hypertens...
...Intravenous Antihypertensive Drugs for Trea...
...able 16. Intravenous Antihypertensive Drugs for...
Patients With Hypertension
...ients With Hypertension
...ity of Care for Patients With Hypertension...
...tensive Medication Adherence Strategies...
...th hypertension, dosing of antihypertensive...
...f combination pills rather than free individua...
...tegies to Promote Lifestyle Modific...
...vioral and motivational strategies to a...
...Team-Based Care Interventions for Hypertensi...
...ed care approach is recommended for...
...alth Record (EHR) and Patient Registries...
...se of the EHR and patient registries is beneficial...
...and patient registries is beneficial for guiding...
...ventions to Improve Hypertension Co...
...egies can be useful adjuncts to interventions sho...
...formance Measu...
...ance measures in combination with other...
...ity Improvement Strategi...
...ty improvement strategies at the hea...
...ial Incentives...
...inancial incentives paid to providers can be use...
...tem financing strategies (e.g., insurance cove...
...lan of Care for Hypertension...
...ith hypertension should have a clear, detailed, an...
...17. Clinician’s Sequential Flow Cha...
...BP Thresholds for and Goals of Pharmac...