Hypertension: Difference between revisions
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Current [[clinical practice guideline]]s are based on The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).<ref name="pmid12748199">{{cite journal |author=Chobanian AV, Bakris GL, Black HR, ''et al'' |title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report |journal=JAMA |volume=289 |issue=19 |pages=2560-72 |year=2003 |pmid=12748199 |doi=10.1001/jama.289.19.2560}} http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf</ref> | Current [[clinical practice guideline]]s are based on The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).<ref name="pmid12748199">{{cite journal |author=Chobanian AV, Bakris GL, Black HR, ''et al'' |title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report |journal=JAMA |volume=289 |issue=19 |pages=2560-72 |year=2003 |pmid=12748199 |doi=10.1001/jama.289.19.2560}} http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf</ref> | ||
==Treatment goals== | ===Treatment goals=== | ||
Per the JNC7 Guidelines:<ref name="pmid12748199"/> | Per the JNC7 Guidelines:<ref name="pmid12748199"/> | ||
* "Treating "most patients" SBP and DBP to targets that are <140/90 mmHg is associated with a decrease in cardiovascular complications. | * "Treating "most patients" SBP and DBP to targets that are <140/90 mmHg is associated with a decrease in cardiovascular complications. | ||
* In patients with hypertension and diabetes or renal disease, the BP goal is <130/80 mmHg. | * In patients with hypertension and diabetes or renal disease, the BP goal is <130/80 mmHg. | ||
==Initial medication== | ===Initial medication=== | ||
Several randomized controlled trials have compared initial medications for hypertension.<ref name="pmid12479763">{{cite journal |author=ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial |title=Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) |journal=JAMA |volume=288 |issue=23 |pages=2981-97 |year=2002 |pmid=12479763 |doi=|url=http://jama.ama-assn.org/cgi/content/full/288/23/2981}}</ref><ref name="pmid12584366">{{cite journal |author=Wing LM, Reid CM, Ryan P, ''et al'' |title=A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly |journal=N. Engl. J. Med. |volume=348 |issue=7 |pages=583-92 |year=2003 |pmid=12584366 |doi=10.1056/NEJMoa021716}}</ref><ref name="pmid8446138">{{cite journal |author=Materson BJ, Reda DJ, Cushman WC, ''et al'' |title=Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents |journal=N. Engl. J. Med. |volume=328 |issue=13 |pages=914-21 |year=1993 |pmid=8446138 |doi=|url=http://content.nejm.org/cgi/content/full/328/13/914}}</ref><ref name="pmid8177286">{{cite journal |author=Materson BJ, Reda DJ |title=Correction: single-drug therapy for hypertension in men |journal=N. Engl. J. Med. |volume=330 |issue=23 |pages=1689 |year=1994 |pmid=8177286 |doi=|url=http://content.nejm.org/cgi/content/full/330/23/1689}}</ref> For patients with Stage 2 Hypertension (SBP <u>></u>160 or DBP<u>></u>100 mmHg), start with two drugs.<ref name="pmid12748199"/> | Several randomized controlled trials have compared initial medications for hypertension.<ref name="pmid12479763">{{cite journal |author=ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial |title=Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) |journal=JAMA |volume=288 |issue=23 |pages=2981-97 |year=2002 |pmid=12479763 |doi=|url=http://jama.ama-assn.org/cgi/content/full/288/23/2981}}</ref><ref name="pmid12584366">{{cite journal |author=Wing LM, Reid CM, Ryan P, ''et al'' |title=A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly |journal=N. Engl. J. Med. |volume=348 |issue=7 |pages=583-92 |year=2003 |pmid=12584366 |doi=10.1056/NEJMoa021716}}</ref><ref name="pmid8446138">{{cite journal |author=Materson BJ, Reda DJ, Cushman WC, ''et al'' |title=Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents |journal=N. Engl. J. Med. |volume=328 |issue=13 |pages=914-21 |year=1993 |pmid=8446138 |doi=|url=http://content.nejm.org/cgi/content/full/328/13/914}}</ref><ref name="pmid8177286">{{cite journal |author=Materson BJ, Reda DJ |title=Correction: single-drug therapy for hypertension in men |journal=N. Engl. J. Med. |volume=330 |issue=23 |pages=1689 |year=1994 |pmid=8177286 |doi=|url=http://content.nejm.org/cgi/content/full/330/23/1689}}</ref> For patients with Stage 2 Hypertension (SBP <u>></u>160 or DBP<u>></u>100 mmHg), start with two drugs.<ref name="pmid12748199"/> | ||
Revision as of 18:02, 22 October 2007
Hypertension is a multisystem disease whose hallmark is the elevation of blood pressure.
Definition
Classification
| Blood pressure classification | Initial blood pressure mm Hg | Followup recommended | |
|---|---|---|---|
| SBP | DBP | ||
| Normal | <120 and | <80 | Recheck in 2 years |
| Prehypertension | 120-139 or | 80-99 | Recheck in 1 year |
| Stage 1 Hypertension | 140-159 or | 90-99 | Confirm within 2 months |
| Stage 2 Hypertension | >160 or | >100 | "Evaluate or refer to source of care within 1 month. For those with higher pressures (e.g., >180/110 mmHg), evaluate and treat immediately or within 1 week depending on clinical situation and complications." |
Diagnosis
Treatment
Current clinical practice guidelines are based on The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).[1]
Treatment goals
Per the JNC7 Guidelines:[1]
- "Treating "most patients" SBP and DBP to targets that are <140/90 mmHg is associated with a decrease in cardiovascular complications.
- In patients with hypertension and diabetes or renal disease, the BP goal is <130/80 mmHg.
Initial medication
Several randomized controlled trials have compared initial medications for hypertension.[2][3][4][5] For patients with Stage 2 Hypertension (SBP >160 or DBP>100 mmHg), start with two drugs.[1]
Systolic hypertension
Prognosis
References
- ↑ 1.0 1.1 1.2 Chobanian AV, Bakris GL, Black HR, et al (2003). "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report". JAMA 289 (19): 2560-72. DOI:10.1001/jama.289.19.2560. PMID 12748199. Research Blogging. http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf
- ↑ ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (2002). "Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)". JAMA 288 (23): 2981-97. PMID 12479763. [e]
- ↑ Wing LM, Reid CM, Ryan P, et al (2003). "A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly". N. Engl. J. Med. 348 (7): 583-92. DOI:10.1056/NEJMoa021716. PMID 12584366. Research Blogging.
- ↑ Materson BJ, Reda DJ, Cushman WC, et al (1993). "Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents". N. Engl. J. Med. 328 (13): 914-21. PMID 8446138. [e]
- ↑ Materson BJ, Reda DJ (1994). "Correction: single-drug therapy for hypertension in men". N. Engl. J. Med. 330 (23): 1689. PMID 8177286. [e]