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
...Diagnosis...
...Risk Factors Common in Patients With...
...nvironmental Risk FactorsHaving trouble vie...
...Coexistence of Hyper...
...ing for and management of other modifiable CV...
...Definition of High...
...e categorized as normal, elevated,...
...able 3. Categories of BP in AdultsaHavin...
...Accurate Measurement of...
...agnosis and management of high BP, proper methods...
...le 4. Checklist for Accurate Measurement...
...on Criteria for BP Cuff Size for Measurement...
...Out-of-Office...
...e BP measurements are recommended to confirm the...
...le 6. Procedures for Use of HBPMHa...
...ble 7. Corresponding Values of SBP/DBP for...
...Masked...
...with an untreated SBP greater than...
...white coat hypertension, periodic monitor...
...ts being treated for hypertension with office B...
...with untreated office BPs that are consi...
...s on multiple-drug therapies for hyp...
...may be reasonable to screen for masked uncontr...
...s being treated for hypertension with elevated...
.... Detection of White Coat Hypertension or Masked...
Table 8. BP Patterns Based on Office and Out-of...
...tion of White Coat Effect or Masked Unco...
...Recommendatio...
...ng for specific form(s) of secondary hyperten...
...adult with sustained hypertension scre...
...igure 3. Screening for Secondary Hypertens...
...able 9. Causes of Secondary Hypert...
...equently Used Medications and Other Substances...
...Primary...
...ts with hypertension, screening for primary al...
Use of the plasma aldosterone: Renin activi...
...s with hypertension and a positive...
...Renal Artery...
...is recommended for adults with atherosclerotic ren...
...renal artery stenosis for whom medical manage...
...Obstructive Sleep...
...dults with hypertension and obstruc...
Patient Evaluation
...Patient Evaluation...
...1. Historical Features Favoring Hypertension Ca...
...c and Optional Laboratory Tests for P...
Treatment and Pharmacological Treatment
...Tr...
...Nonpha...
...loss is recommended to reduce BP in adults wi...
...eart-healthy diet, such as the DASH (Dietary...
...on is recommended for adults with elevated BP...
...mentation, preferably in dietary modifi...
...reased physical activity with a structured exe...
...men and women with elevated BPa or hypertension w...
...13. Best Proven Nonpharmacological...
BP Trea...
SBP (I, A)573
...I, C-EO)573...
...ing medication is recommended for primary...
...BP Goal for...
SBP (I, B-R)(SR)5...
...(I, C-EO)57...
...IIb, B-NR)57...
DBP (IIb, C-EO)57...
...Choice of Initial Medicat...
...ation of antihypertensive drug therapy, first-line...
...antihypertensive drug therapy with 2 fir...
...tion of antihypertensive drug thera...
...F...
...ng a new or adjusted drug regimen for hypertension...
...Monito...
Follow-up and monitoring after ini...
...Gen...
...eous use of an ACE inhibitor, ARB, and...
...gure 4. BP Thresholds and Recommendations for Tre...
...Follow-Up After Initi...
...ith an elevated BP or stage 1 hypertension w...
...stage 1 hypertension who have an e...
...age 2 hypertension should be evaluated by or...
...th a very high average BP (e.g., SBP ≥...
...ults with a normal BP, repeat evaluation ev...
...Antihypertensive DrugsHaving trouble viewi...
Hypertension in Patients With Comorbidities
...Hypertension in Pat...
...Stable I...
SBP (I, B-R)5...
...(I, C-EO)573...
...(I, B-R)573...
...(I, C-EO)57...
...with SIHD with angina and persistent uncont...
...dults who have had a MI or acute corona...
...ckers and/or CCBs might be considered to...
.... Management of Hypertension in Patients Wit...
...(I, B-R)573...
...(I, C-EO)573...
...Heart...
...HFrEF and hypertension should be prescribe...
...ine CCBs are NOT recommended in the treatment...
...Heart F...
...s with HFpEF who present with symptoms of...
...FpEF and persistent hypertension after management...
SBP (I, B-R)(SR)5...
...BP (I, C-EO)573...
...ith hypertension and CKD (stage 3 or higher or...
In adults with hypertension and CKD...
...gure 6. Management of Hypertension...
...Acute Intracerebra...
...lts with ICH who present with SBP gr...
...ediate lowering of SBP (Table 14) to less...
...7. Management of Hypertension in Patients wit...
...Acute Ischemic...
...ults with AIS and elevated BP who are elig...
...s with an AIS, BP should be less than 185/1...
...ng or restarting antihypertensive therapy during...
...s with BP of 220/120 mm Hg or higher who did not r...
In patients with BP less than 220/120 mm Hg...
...gement of Hypertension in Patients With A...
...Secondar...
...previously treated hypertension who experience a...
...experience a stroke or TIA, treat...
...reviously treated for hypertension who exp...
...dults who experience a stroke or TIA, select...
...experience a stroke or TIA, a BP goal...
...or adults with a lacunar stroke, a target SBP goa...
...ously untreated for hypertension who ex...
...anagement of Hypertension in Patients With a...
...Other...
...Hypertension Aft...
...(IIa, B-NR)573...
...P (IIa, C-EO)573
...ey transplantation, it is reasonab...
...Peripheral Artery Disease...
...pertension and PAD should be treated similar...
...Diabetes Mel...
..., B-R)(SR)573...
DBP (I, C-EO)57...
...th DM and hypertension, all first-li...
...adults with DM and hypertension, ACE inhibito...
Atrial Fibri...
...tment of hypertension with an ARB can be...
...Valvular Heart Disease...
...ults with asymptomatic aortic sten...
...nts with chronic aortic insufficien...
...Aorti...
Beta blockers are recommended as the prefer...
In black adults with hypertension...
...r more antihypertensive medications are recommen...
...Pregnan...
...pertension who become pregnant, or a...
...ypertension who become pregnant should NOT be t...
...atment of hypertension with a SBP treatm...
...lts (≥65 years of age) with hypertension...
...Cognitive Decline and Deme...
...n adults with hypertension, BP lowering i...
...Patient...
...Preoperative...
...ith hypertension undergoing major surgery who...
...patients with hypertension undergoing plann...
...h hypertension undergoing major surg...
...patients with planned elective major surgery an...
...ients undergoing surgery, abrupt pr...
...lockers should NOT be started on the day...
...In...
...ith intraoperative hypertension should be...
Resistant Hypertension
R...
...e 10. Resistant Hypertension: Diagnosis, Evaluat...
...Hypertensive Crises—Emerg...
...ith a hypertensive emergency, admission t...
...with a compelling condition (i.e., aorti...
...ts without a compelling condition, SBP should be...
...11. Diagnosis and Management of a Hypertens...
...able 15. Intravenous Antihypertensive Dru...
...Intravenous Antihypertensive Drugs for Tr...
Patients With Hypertension
...Patients With Hypert...
...Improving Qualit...
...Antihy...
...with hypertension, dosing of antihyperte...
...ination pills rather than free individual co...
...Strategies to Pro...
...ioral and motivational strategies to achieve a...
...S...
...eam-based care approach is recomme...
...e of the EHR and patient registries is be...
...of the EHR and patient registries is benefic...
...Telehealth Intervention...
...elehealth strategies can be useful adjuncts...
...P...
...e of performance measures in combinati...
...Quality Improvement Stra...
...ality improvement strategies at the health system,...
...Fina...
...incentives paid to providers can be useful i...
...m financing strategies (e.g., insuran...
...The Plan of...
...hypertension should have a clear,...
...ician’s Sequential Flow Chart for the Mana...
...8. BP Thresholds for and Goals of...