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
Diagnosi...
...1. CVD Risk Factors Common in Patien...
...e 2. Environmental Risk FactorsHaving...
Coexistence of Hypertension and Related Chro...
...reening for and management of other modifiable...
...inition of High BP...
...be categorized as normal, elevated, or sta...
...le 3. Categories of BP in AdultsaHaving trouble v...
...ate Measurement of BP in the Office...
...nd management of high BP, proper methods are rec...
...4. Checklist for Accurate Measurement of BP...
...5. Selection Criteria for BP Cuff Size...
...and Self-Monitoring of BP
...ut-of-office BP measurements are recomme...
...ble 6. Procedures for Use of HBPMHaving trouble...
...onding Values of SBP/DBP for Clinic, HBPM, Dayti...
Masked and White Coat Hypertensio...
...n untreated SBP greater than 130 mm...
...h white coat hypertension, periodic mon...
...lts being treated for hypertension with office...
...untreated office BPs that are consistently betw...
...tiple-drug therapies for hypertension and office...
...sonable to screen for masked uncontrolled...
...dults being treated for hypertension with...
...tection of White Coat Hypertension or Masked H...
...able 8. BP Patterns Based on Offic...
...tection of White Coat Effect or Masked Unco...
...ations for Secondary Forms of Hypertension...
...for specific form(s) of secondary hy...
...ith sustained hypertension screens positive...
...e 3. Screening for Secondary Hypert...
...uses of Secondary Hypertension With C...
...requently Used Medications and Other Substances...
...imary Aldosteronism...
...th hypertension, screening for primary a...
Use of the plasma aldosterone: Renin activi...
...ults with hypertension and a positive...
...l Artery Stenosis...
...edical therapy is recommended for adults with...
...n adults with renal artery stenosis for whom me...
...tructive Sleep Apne...
...ypertension and obstructive sleep apnea, the e...
Patient Evaluation
...atient Evaluation...
...rical Features Favoring Hypertension C...
...asic and Optional Laboratory Tests for Primary H...
Treatment and Pharmacological Treatment
...ent and Pharmacological Treatm...
...onpharmacological Inte...
...ss is recommended to reduce BP in adults with elev...
...y diet, such as the DASH (Dietary Approaches to...
...um reduction is recommended for adul...
...supplementation, preferably in dietary modifica...
...hysical activity with a structured exercise progra...
...men and women with elevated BPa or hypertensio...
Table 13. Best Proven Nonpharmacological Inte...
...Treatment Threshold and the Use of CVD Ri...
SBP (I, A)5...
...I, C-EO)573...
...wering medication is recommended for...
...for Patients With Hypertension...
...BP (I, B-R)(SR)573
...P (I, C-EO)5...
SBP (IIb, B-NR...
...(IIb, C-EO)573...
...oice of Initial Medicat...
...r initiation of antihypertensive drug th...
...itiation of antihypertensive drug therapy wit...
...f antihypertensive drug therapy with a...
...low-Up After Initiating Antihypertens...
...ing a new or adjusted drug regimen for...
...trategies to Improve Control of BP in Patients o...
...llow-up and monitoring after initiati...
General Principle of Drug...
...aneous use of an ACE inhibitor, ARB, and/or ren...
...esholds and Recommendations for Treatment and...
...After Initial BP Evaluation...
...lts with an elevated BP or stage 1 hypertens...
...ith stage 1 hypertension who have an estim...
Adults with stage 2 hypertension should be evaluat...
...or adults with a very high average...
...adults with a normal BP, repeat evalu...
...Antihypertensive DrugsHaving trouble view...
Hypertension in Patients With Comorbidities
...in Patients With Comorbidities...
...able Ischemic Heart D...
...BP (I, B-R)573...
...P (I, C-EO)...
...(I, B-R)573...
...I, C-EO)573...
...th SIHD with angina and persistent uncontr...
...ults who have had a MI or acute coronary syndro...
...blockers and/or CCBs might be considered to con...
...gement of Hypertension in Patients With S...
...t Failure...
...I, B-R)573...
...(I, C-EO)573...
...ilure With Reduced Ejection Fraction (HFrEF...
...with HFrEF and hypertension should be...
...hydropyridine CCBs are NOT recommended in the trea...
...With Preserved Ejection Fraction (HFpEF)...
...adults with HFpEF who present with symptoms of...
...FpEF and persistent hypertension after...
...nic Kidney Disease...
...I, B-R)(SR)573...
...I, C-EO)573...
...lts with hypertension and CKD (stage 3 or...
...lts with hypertension and CKD (stage 3...
...anagement of Hypertension in Patients...
...te Intracerebral Hemorrhage...
...lts with ICH who present with SBP great...
...ate lowering of SBP (Table 14) to less th...
...ure 7. Management of Hypertension in Patients...
...Ischemic Stroke (AI...
...and elevated BP who are eligible for treatment w...
...with an AIS, BP should be less than 185/110...
Starting or restarting antihypertensive therap...
In patients with BP of 220/120 mm Hg or hig...
...n patients with BP less than 220/120 mm...
Figure 8. Management of Hypertensio...
...ndary Stroke Preven...
...h previously treated hypertension who experie...
...ts who experience a stroke or TIA, treatment w...
...t previously treated for hypertension who...
For adults who experience a stroke or TIA, select...
...dults who experience a stroke or TIA, a BP goa...
...ults with a lacunar stroke, a target S...
...iously untreated for hypertension who experien...
...9. Management of Hypertension in Patients With...
...ther Comorbidi...
...pertension After Renal Transplantat...
...(IIa, B-NR)573...
...P (IIa, C-EO)5...
...fter kidney transplantation, it is reasonable to t...
...al Artery Disease...
Adults with hypertension and PAD shou...
...abetes Mellitu...
SBP (I, B-R)(SR...
...BP (I, C-EO)57...
In adults with DM and hypertension, a...
In adults with DM and hypertension, ACE inhibit...
...l Fibrillation
...ment of hypertension with an ARB can be...
...lar Heart Diseas...
...lts with asymptomatic aortic steno...
...with chronic aortic insufficiency, treatment...
...rtic Disease...
Beta blockers are recommended as the pref...
...d Ethnic Differences in Treatment...
...ts with hypertension but without HF or C...
...ore antihypertensive medications are recommended t...
...regnanc...
...h hypertension who become pregnant, or are plan...
...ertension who become pregnant should NOT be treat...
...r Persons...
...nt of hypertension with a SBP trea...
...(≥65 years of age) with hypertension...
...Decline and Dementia...
...n adults with hypertension, BP loweri...
...ents Undergoing Surgical Procedur...
Preoperativ...
...ith hypertension undergoing major sur...
...s with hypertension undergoing planned electi...
...patients with hypertension undergoing ma...
...ts with planned elective major surger...
...ergoing surgery, abrupt preoperative discont...
...blockers should NOT be started on the...
Intraoperat...
...ntraoperative hypertension should be...
Resistant Hypertension
...stant Hypertensio...
.... Resistant Hypertension: Diagnosis, Evaluation...
...nsive Crises—Emergencies and Urgencies...
...hypertensive emergency, admission t...
For adults with a compelling condition (i.e.,...
...ut a compelling condition, SBP shou...
.... Diagnosis and Management of a Hyperte...
Table 15. Intravenous Antihypertensive Drugs fo...
...avenous Antihypertensive Drugs for Treatment of...
Patients With Hypertension
...nts With Hypertension...
...proving Quality of Care for Patients With...
...ensive Medication Adherence Strategies...
...dults with hypertension, dosing of antih...
...of combination pills rather than free individual...
...to Promote Lifestyle Modification...
...avioral and motivational strategies to ach...
...eam-Based Care Interventions for Hypertensio...
...team-based care approach is recommended...
...c Health Record (EHR) and Patient Registries...
...EHR and patient registries is benefi...
...and patient registries is beneficial for guiding q...
...health Interventions to Improve Hypertension Co...
...ealth strategies can be useful adjuncts...
...rmance Measure...
...rmance measures in combination with othe...
...Improvement Strategies...
...quality improvement strategies at the health...
...ncial Incentives...
...entives paid to providers can be usefu...
...inancing strategies (e.g., insurance co...
...he Plan of Care for Hy...
...h hypertension should have a clear,...
.... Clinician’s Sequential Flow Chart for the...
...BP Thresholds for and Goals of Pharma...