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

Published: November 2017
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  • Key Points
  • Recommendations
    • Coexistence of Hypertension and Related Chronic Conditions
    • Definition of High BP
    • Accurate Measurement of BP in the Office
    • Out-of-Office and Self-Monitoring of BP
    • Masked and White Coat Hypertension
    • Recommendations for Secondary Forms of Hypertension
    • Primary Aldosteronism
    • Renal Artery Stenosis
    • Obstructive Sleep Apnea
    • Nonpharmacological Interventions
    • BP Treatment Threshold and the Use of CVD Risk Estimation to Guide Drug Treatment of Hypertension
    • BP Goal for Patients With Hypertension
    • Choice of Initial Medication
    • Follow-Up After Initiating Antihypertensive Drug Therapy
    • Monitoring Strategies to Improve Control of BP in Patients on Drug Therapy for High BP
    • General Principle of Drug Therapy
    • Follow-Up After Initial BP Evaluation
    • Stable Ischemic Heart Disease
    • Heart Failure
    • Chronic Kidney Disease
    • Acute Intracerebral Hemorrhage (ICH)
    • Acute Ischemic Stroke (AIS)
    • Secondary Stroke Prevention
    • Other Comorbidities
    • Hypertensive Crises—Emergencies and Urgencies
    • Improving Quality of Care for Patients With Hypertension
    • Financial Incentives
    • The Plan of Care for Hypertension
  • Algorithms
    • Detection of White Coat Hypertension or Masked Hypertension in Patients Not on Drug Therapy
    • Detection of White Coat Effect or Masked Uncontrolled Hypertension in Patients on Drug Therapy
    • Screening for Secondary Hypertension
    • BP Thresholds and Recommendations for Treatment and Follow-Up
    • Management of Hypertension in Patients With SIHD
    • Management of Hypertension in Patients With CKD
    • Management of Hypertension in Patients with Acute ICH
    • Management of Hypertension in Patients With Acute Ischemic Stroke
    • Management of Hypertension in Patients With a Previous History of Stroke (Secondary Stroke Prevention)
    • Resistant Hypertension: Diagnosis, Evaluation, and Treatment
    • Diagnosis and Management of a Hypertensive Crisis
  • Tables
    • CVD Risk Factors Common in Patients With Hypertension
    • Environmental Risk Factors
    • Categories of BP in Adults
    • Checklist for Accurate Measurement of BP
    • Selection Criteria for BP Cuff Size for Measurement of BP in Adults
    • Procedures for Use of HBPM
    • Corresponding Values of SBP/DBP for Clinic, HBPM, Daytime, Nighttime, and 24-Hour Ambulatory Blood Pressure Monitoring (ABPM) Measurements
    • BP Patterns Based on Office and Out-of-Office Measurements
    • Causes of Secondary Hypertension With Clinical Indications and Diagnostic Screening Tests
    • Frequently Used Medications and Other Substances That May Cause Elevated BP
    • Historical Features Favoring Hypertension Cause
    • Basic and Optional Laboratory Tests for Primary Hypertension
    • Best Proven Nonpharmacological Interventions for Prevention and Treatment of Hypertension
    • Oral Antihypertensive Drugs
    • Intravenous Antihypertensive Drugs for Treatment of Hypertensive Emergencies
    • Intravenous Antihypertensive Drugs for Treatment of Hypertensive Emergencies in Patients With Selected Comorbidities
    • Clinician’s Sequential Flow Chart for the Management of Hypertension
    • BP Thresholds for and Goals of Pharmacological Therapy in Patients With Hypertension According to Clinical Conditions
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The American College of Cardiology (ACC) continues to transform quality cardiovascular care and improve heart health after more than 60 years of existence through its mission, vision and values. The College is proud of its efforts to bring evidence-based clinical care into everyday practice.

Our mission is to build healthier lives, free of cardiovascular diseases and stroke. That single purpose drives all we do. AHA's Professional Membership is a made up of a robust group of cardiovascular professionals who participate in discovery and dissemination of science.


This pocket guide attempts to define principles of practice that should produce high-quality patient care. It is applicable to specialists, primary care, and providers at all levels. This pocket guide should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician after consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool.


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