Recommendation for Hypertension Screening

for the HealthCare Professional

Hypertension1

  • Defined as systolic blood pressure (SBP) ≥140 mmHg, diastolic blood pressure (DBP) ≥90 mmHg, or patients taking antihypertensive medications
  • Goal blood pressure in patients is <140/90 mmHg
  • Goal blood pressure in patients with diabetes or chronic kidney disease is <130/80
  • chronic kidney disease is defined as a CLcr < 60 ml/min, the presence of albuminuria (> 300 mg/day or > 200 mg albumin/g creatinine spot ratio), or a serum creatinine of > 1.3 g/dL for women and > 1.5 g/dL for men
  • Individuals with normal blood pressure levels at 55 years of age have a 90% lifetime risk of developing hypertension

Risk Factors for Hypertension1-3,5

  • Patients with pre-hypertension
  • Cigarette smoking
  • Obesity (BMI ≥ 30 kg/m2)
  • Physical Inactivity
  • Dyslipidemia
  • Diabetes Mellitus
  • Microalbuminuria or estimated GRF < 60mL/min
  • Age (>55 years for men; >65 years for women)
  • Family History of premature cardiovascular disease or hypertension
  • Men <55 years; Women <65 years
  • African American (black) ancestry
  • Excessive alcohol consumption
  • Excessive dietary sodium intake
  • Insufficient intake of potassium

Intervention and Prevention of Hypertension1-3

  • Smoking cessation
  • Weight loss (BMI < 25kg/m2)
  • Increased physical activity
  • ≥30 minutes on most, if not all, days of the week
  • Decreased intake of dietary saturated fat and cholesterol
  • Moderation of alcohol consumption

Men / Women
EtOH / 1 oz./day / ½ oz./day
  • Diet modification (high intake of fruits, veggies, low fat dairy)
  • Reduced intake of dietary sodium (≤ 6gm NaCl/day or 2.4gm Na/day)
  • Potassium supplementation (3.5gm/day)
  • Maintain adequate intake of Calcium and Magnesium

Drug-Related Causes of Hypertension1-3

  • NSAIDs
  • Cocaine, Amphetamines, other Illicit drugs
  • Sympathomimetics (decongestants/anorectics)
  • Oral Contraceptives
  • Adrenal Steroids
  • Cyclosporine/Tacrolimus
  • Erythropoietin
  • Licorice (including some chewing tobacco)
  • Selected OTC dietary supplements (ephedra, ma haung, bitter orange)
  • Caffeine
  • Certain antidepressants

Classification and Management of Blood Pressure (Adults ≥18 years)1

BP Classification / SBP* (mmHg) / DBP* (mmHg) / Lifestyle Modification / Initial Drug Therapy
Without Compelling Indication / With Compelling Indications
Normal / <120 / and <80 / Encourage / No antihypertensive drug indicated / Drugs for compelling indications†
Pre-Hypertension / 120-139 / or 80-89 / Yes
Stage 1 Hypertension / 140-159 / or 90-99 / Yes /
  • Thiazide-type diuretic for most
  • Consider ACE-I, ARB, BB, CCB, or combination
/ Drugs for compelling indications†
Stage 2 Hypertension / ≥160 / or ≥100 / Yes /
  • Two drug combination for most
/ Drugs for compelling indications†

Abbreviations: ACE-I: Ace Inhibitor; ARB: Angiotensin-Receptor Blocker; BB: beta-blocker; CCB: calcium channel blocker.

*treatment determined by highest BP category

† treat patients with chronic kidney disease or diabetes to BP goal of ≤ 130/80 mmHg

Compelling Indications1

High Risk Conditions with Compelling Indications / Diuretic / BB / ACE-I / ARB / CCB / Aldosterone Antagonist
Heart Failure
Post-MI
High Coronary Disease Risk
Diabetes
Chronic Kidney Disease
Recurrent Stroke Prevention

Useful Sites and Resources

  • National Heart, Lung, and Blood Institute (NHLBI) Information Center, PO Box 30105, Bethesda, MD 20824-0105; (301)251-1222 or (800) 575-WELL
  • Internet Address:

References

1Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 2003; 289:2560-72.

2Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA 2002 Oct 16;288(15):1882-8.

3Hawkins DW, Bussey HI, Prisant LM. Hypertension. In: Pharmacotherapy: a pathophysiologic approach 4th ed. Eds: DiPiro JT, Talbert RL, Yee GC, et al. 131-152.

4Anon. Your guide to lowering high blood pressure. At NHLBI website. Available at:

(cited 11/20/02).

5National Institute of Health. National Heart, Lung, and Blood Institute. The JNC VII Guide to Prevention and Treatment of Hypertension Recommendations. Available at