Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

Publication Date: November 13, 2017

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

...agnosis...

...e 1. CVD Risk Factors Common in Patien...


...vironmental Risk FactorsHaving troubl...


...istence of Hypertension and Related Chr...

...g for and management of other modifiable CV...


...tion of High BP...

...ould be categorized as normal, elev...


...egories of BP in AdultsaHaving trouble viewin...


Accurate Measurement of BP in...

...sis and management of high BP, proper methods ar...


...e 4. Checklist for Accurate Measurement of BPHa...


...ection Criteria for BP Cuff Size for Measurement o...


...fice and Self-Monitoring of BP...

...ffice BP measurements are recommended...


...ocedures for Use of HBPMHaving trouble v...


...esponding Values of SBP/DBP for Clin...


...sked and White Coat Hyperte...

...ith an untreated SBP greater than 130 mm H...

...adults with white coat hypertension, pe...

...s being treated for hypertension wi...

...with untreated office BPs that are consistently...

...on multiple-drug therapies for hype...

...nable to screen for masked uncontrolled hyp...

...being treated for hypertension with eleva...


...igure 1. Detection of White Coat Hyper...


...Patterns Based on Office and Out-of-Office Me...


...e 2. Detection of White Coat Effect or Masked Unco...


...for Secondary Forms of Hypertension...

...r specific form(s) of secondary hypertensi...

...lt with sustained hypertension scree...


.... Screening for Secondary Hypertension...


...es of Secondary Hypertension With...


Table 10. Frequently Used Medications and Other...


...imary Aldosteronism...

...adults with hypertension, screening for...

...the plasma aldosterone: Renin activit...

...n adults with hypertension and a positive scre...


...enal Artery St...

...edical therapy is recommended for adults with at...

...ults with renal artery stenosis for whom medica...


...structive Sleep A...

...adults with hypertension and obstructive sleep apn...


Patient Evaluation

...t Evaluation...

...storical Features Favoring Hypertensio...


...ic and Optional Laboratory Tests for Primary Hy...


Treatment and Pharmacological Treatment

...and Pharmacological Treatmen...

...rmacological Interventions...

...eight loss is recommended to reduce BP...

...lthy diet, such as the DASH (Dietary App...

...uction is recommended for adults with ele...

...sium supplementation, preferably in dieta...

...al activity with a structured exercise...

...d women with elevated BPa or hypertension...


...t Proven Nonpharmacological Interventions for...


BP Treatment Threshold and the Use of CV...

...(I, A)573...

...P (I, C-EO)57...

...owering medication is recommended for p...


...Goal for Patients With Hypertens...

...P (I, B-R)(SR...

DBP (I, C-EO...

...(IIb, B-NR)573...

...IIb, C-EO)573...


...Initial Medication...

...itiation of antihypertensive drug therapy, first-...

...f antihypertensive drug therapy with 2 first-l...

...ntihypertensive drug therapy with a single an...


...p After Initiating Antihypertensive Dr...

...ting a new or adjusted drug regimen for hype...


...Strategies to Improve Control of BP in...

...low-up and monitoring after initiation...


...inciple of Drug Therapy...

...aneous use of an ACE inhibitor, ARB, and/or reni...


...Thresholds and Recommendations for...


...llow-Up After Initial BP Ev...

...n elevated BP or stage 1 hypertension wh...

...ith stage 1 hypertension who have an est...

...e 2 hypertension should be evaluate...

...or adults with a very high average...

...s with a normal BP, repeat evaluation every year i...


...14. Oral Antihypertensive DrugsHaving tro...


Hypertension in Patients With Comorbidities

...n in Patients With Comorbidities...

...le Ischemic Heart Disea...

...BP (I, B-R...

DBP (I, C-EO)573

...I, B-R)573...

...P (I, C-EO)573...

...s with SIHD with angina and persistent...

...adults who have had a MI or acute coronary syn...

...rs and/or CCBs might be considered to contro...


...agement of Hypertension in Patients...


...art Failure...

...(I, B-R)573...

...BP (I, C-EO)573...

...lure With Reduced Ejection Fraction (HFr...

...rEF and hypertension should be prescribed GDM...

...ihydropyridine CCBs are NOT recommen...

...eart Failure With Preserved Ejection Fraction (HFp...

...ults with HFpEF who present with symp...

...with HFpEF and persistent hypertension after...


...hronic Kidney Dise...

...(I, B-R)(SR)57...

...I, C-EO)573...

...n adults with hypertension and CKD (st...

...lts with hypertension and CKD (stage 3...


...nagement of Hypertension in Patients With C...


...racerebral Hemorrhage (ICH)...

...with ICH who present with SBP greater than...

...owering of SBP (Table 14) to less tha...


...re 7. Management of Hypertension in Patients...


...cute Ischemic Stroke...

...and elevated BP who are eligible for trea...

...ith an AIS, BP should be less than 185/110...

Starting or restarting antihypertensive t...

...with BP of 220/120 mm Hg or higher who did not...

In patients with BP less than 220/120 m...


...anagement of Hypertension in Patients W...


...ndary Stroke Prevention...

...ith previously treated hypertension who experien...

...adults who experience a stroke or TIA, tre...

...lts not previously treated for hyperten...

...who experience a stroke or TIA, selection of sp...

...r adults who experience a stroke or TI...

...ts with a lacunar stroke, a target...

...usly untreated for hypertension wh...


Figure 9. Management of Hypertension in...


...Comorbidities...

...sion After Renal Transplantat...

...IIa, B-NR)573

...(IIa, C-EO)57...

...transplantation, it is reasonable to tre...

...ripheral Artery Disea...

...ults with hypertension and PAD should be...

...tes Mellitus

..., B-R)(SR)573...

...I, C-EO)573...

...adults with DM and hypertension, all first-line...

...adults with DM and hypertension, ACE in...

...al Fibrillation...

...of hypertension with an ARB can be use...

Valvular Heart Diseas...

...s with asymptomatic aortic stenosis, hyp...

...ith chronic aortic insufficiency, treatment...

...rtic Disease...

...blockers are recommended as the preferre...

...Ethnic Differences in Treatment...

...lts with hypertension but without HF or CKD, incl...

...or more antihypertensive medications a...

...egnancy...

...with hypertension who become pregnant,...

...rtension who become pregnant should NO...

...lder Person...

...atment of hypertension with a SBP treatment g...

...der adults (≥65 years of age) with hyp...

Cognitive Decline and Deme...

...hypertension, BP lowering is reasonable t...

...rgoing Surgical Procedures...

...perative

...th hypertension undergoing major su...

In patients with hypertension undergo...

...ith hypertension undergoing major surge...

...ients with planned elective major surgery and SB...

...undergoing surgery, abrupt preoperative discont...

...should NOT be started on the day of surgery in...

...aoperative...

...s with intraoperative hypertension should be...


Resistant Hypertension

...esistant Hypertension...

Figure 10. Resistant Hypertension: Diagnosi...


...Crises—Emergencies and Urgencies...

...dults with a hypertensive emergency, admis...

...with a compelling condition (i.e., aortic d...

...without a compelling condition, SBP...


...11. Diagnosis and Management of a Hyp...


...travenous Antihypertensive Drugs for Trea...


Table 16. Intravenous Antihypertensive D...


Patients With Hypertension

...ents With Hypertension...

...Quality of Care for Patients With Hy...

...ypertensive Medication Adherence Strategies

...s with hypertension, dosing of antihypertensive...

...on pills rather than free individual...

...s to Promote Lifestyle Modificatio...

...avioral and motivational strategie...

...Team-Based Care Interventions for Hypertension Co...

...ed care approach is recommended for adul...

...h Record (EHR) and Patient Registries...

...the EHR and patient registries is bene...

...se of the EHR and patient registries is...

...rventions to Improve Hypertension Con...

...ehealth strategies can be useful adjuncts to i...

...mance Measures

...of performance measures in combina...

...mprovement Strategies...

...quality improvement strategies at the hea...


...ancial Incentives...

...ial incentives paid to providers can be use...

...financing strategies (e.g., insurance cov...


...he Plan of Care for Hyper...

...y adult with hypertension should have a clear...


...le 17. Clinician’s Sequential Flow Chart f...


...e 18. BP Thresholds for and Goals of Pharma...