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
...Dia...
...Risk Factors Common in Patients With Hypertension...
...ironmental Risk Factors Overwe...
...Coexistence of H...
...nd management of other modifiable CVD risk factors...
...Definition of High B...
...be categorized as normal, elevated, or...
...e 3. Categories of BP in Adultsa...
Accurate...
...r diagnosis and management of high BP...
...4. Checklist for Accurate Measuremen...
...e 5. Selection Criteria for BP Cuff Size for Measu...
...Out-of-Of...
...f-office BP measurements are recommended to conf...
...e 6. Procedures for Use of HBPM...
...orresponding Values of SBP/DBP for Clinic,...
...Masked and White...
...dults with an untreated SBP greate...
...h white coat hypertension, periodic moni...
...g treated for hypertension with office BP r...
...dults with untreated office BPs that...
...lts on multiple-drug therapies for hypertens...
...reasonable to screen for masked un...
...dults being treated for hypertension with e...
...tection of White Coat Hypertension or Masked Hyper...
...erns Based on Office and Out-of-Offi...
...gure 2. Detection of White Coat Effect or...
...Recommendations f...
...ing for specific form(s) of second...
...with sustained hypertension screen...
...igure 3. Screening for Secondary Hypertensio...
...uses of Secondary Hypertension With Clinical Indi...
...e 10. Frequently Used Medications and Other Su...
...Primary A...
...ts with hypertension, screening for primary a...
...asma aldosterone: Renin activity rati...
...lts with hypertension and a positive screening t...
...Renal Artery Stenos...
...is recommended for adults with athero...
...ts with renal artery stenosis for whom...
...Obstructive...
...n adults with hypertension and obstruct...
Patient Evaluation
...Patient...
...Historical Features Favoring Hypertension C...
...e 12. Basic and Optional Laboratory Tests for P...
Treatment and Pharmacological Treatment
Treatment...
...Nonpharmacolo...
...s recommended to reduce BP in adults with el...
...-healthy diet, such as the DASH (Di...
...uction is recommended for adults with elev...
...ssium supplementation, preferably in dietary m...
...sed physical activity with a structured exerc...
...men with elevated BPa or hypertension who curren...
...ble 13. Best Proven Nonpharmacological Intervent...
...BP Treatment Thre...
SBP (I, A)5...
DBP (I, C-EO)...
...ering medication is recommended fo...
...BP Goal for Patients With...
...(I, B-R)(SR)...
...I, C-EO)573
...Ib, B-NR)573...
...Ib, C-EO)573...
...Choice of Initial Medicatio...
...ion of antihypertensive drug therapy, first-line...
Initiation of antihypertensive drug t...
...of antihypertensive drug therapy with a...
...Follow-Up After Initiating A...
...itiating a new or adjusted drug regimen fo...
...Monitoring...
...low-up and monitoring after initiation of drug...
...General Pri...
Simultaneous use of an ACE inhibitor, ARB, and/o...
...4. BP Thresholds and Recommendations for Treatm...
...Follow-Up After Init...
...th an elevated BP or stage 1 hypertension who...
...with stage 1 hypertension who have an estim...
...age 2 hypertension should be evalu...
For adults with a very high average BP...
For adults with a normal BP, repeat evaluation eve...
...ral Antihypertensive Drugs...
Hypertension in Patients With Comorbidities
...Hypertension in Patients W...
...Stable Is...
...I, B-R)573...
...BP (I, C-EO)5...
...I, B-R)573...
...(I, C-EO)573
...n adults with SIHD with angina and persistent un...
...have had a MI or acute coronary syndrome,...
...and/or CCBs might be considered to control...
...anagement of Hypertension in Patients...
...Heart Failure...
...(I, B-R)573...
DBP (I, C-EO)5...
Heart Fai...
...ith HFrEF and hypertension should be pr...
...ine CCBs are NOT recommended in the trea...
...Heart Failure W...
...with HFpEF who present with sympt...
...s with HFpEF and persistent hypertension after...
...Chronic Kidney Disease...
...BP (I, B-R)(S...
...(I, C-EO)573...
...dults with hypertension and CKD (stage 3 or...
...th hypertension and CKD (stage 3 or...
...Management of Hypertension in Patients W...
Acu...
...n adults with ICH who present with SBP greater t...
...ng of SBP (Table 14) to less than 140 mm...
...gement of Hypertension in Patients wi...
...Acute Isch...
...ults with AIS and elevated BP who are eligible fo...
...an AIS, BP should be less than 185...
...r restarting antihypertensive therapy during h...
...with BP of 220/120 mm Hg or higher who did not...
...atients with BP less than 220/120 mm Hg...
...nagement of Hypertension in Patients With Acute...
...Secondary...
...th previously treated hypertension who experien...
...adults who experience a stroke or TI...
...not previously treated for hyperte...
...dults who experience a stroke or TIA, selec...
...ults who experience a stroke or TIA...
...or adults with a lacunar stroke, a ta...
...s previously untreated for hypertension who exper...
.... Management of Hypertension in Pati...
...Other C...
...Hypertension Af...
...P (IIa, B-NR)...
...BP (IIa, C-E...
...ansplantation, it is reasonable to treat patients...
...Peripheral Artery...
...with hypertension and PAD should be...
...Diabetes Mellitus...
..., B-R)(SR)573...
...(I, C-EO)573...
...ults with DM and hypertension, all first-line...
...with DM and hypertension, ACE inhibi...
...hypertension with an ARB can be use...
...Valvular Hear...
...symptomatic aortic stenosis, hypertension sh...
...h chronic aortic insufficiency, treat...
...Aortic Dis...
...ers are recommended as the preferred...
...Racial a...
...with hypertension but without HF or CKD, including...
...o or more antihypertensive medications are recomm...
...Pregnancy...
...hypertension who become pregnant, or are planni...
...tension who become pregnant should NOT b...
...Older Per...
...of hypertension with a SBP treatment go...
...adults (≥65 years of age) with hype...
...Cogniti...
...ults with hypertension, BP lowering is reasonable...
...Patients Underg...
...Preopera...
...ents with hypertension undergoing ma...
...n patients with hypertension undergoing plann...
...nts with hypertension undergoing major surgery, di...
...with planned elective major surgery and SB...
...ients undergoing surgery, abrupt preoperative dis...
...a blockers should NOT be started on the d...
...Intraoper...
Patients with intraoperative hypertension shoul...
Resistant Hypertension
...Resistant Hypertens...
...ure 10. Resistant Hypertension: Diagnosis,...
...Hypertensive Cr...
...th a hypertensive emergency, admiss...
...a compelling condition (i.e., aortic...
For adults without a compelling condit...
...gnosis and Management of a Hypertensive Crisis...
...avenous Antihypertensive Drugs for Tre...
...le 16. Intravenous Antihypertensiv...
Patients With Hypertension
...Pat...
...Improving Q...
...Antihype...
...lts with hypertension, dosing of antihyp...
...nation pills rather than free individual compo...
Strat...
...ehavioral and motivational strateg...
...Structured, Team-Ba...
...ased care approach is recommended for adults with...
...Electronic Healt...
...R and patient registries is beneficial for...
...R and patient registries is beneficial for gui...
...Telehe...
...th strategies can be useful adjuncts to...
...Performance Me...
...se of performance measures in combinati...
...Quality Improvement Strateg...
...improvement strategies at the health system,...
...Fin...
...ancial incentives paid to providers...
Health system financing strategies (e.g....
...The Plan of C...
...adult with hypertension should have...
...ble 17. Clinician’s Sequential Flow...
...Thresholds for and Goals of Pharmacolog...