Chronic hypertension classification: Difference between revisions

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Latest revision as of 20:09, 17 May 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Yazan Daaboul, Serge Korjian, Usama Talib, BSc, MD [2]

Overview

In 2004, the Seventh Report of the Joint National Committee (JNC 7) classified blood pressure values into 4 categories: normal, prehypertension, stage I hypertension, and stage II hypertension.^[1] In 2007, the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) classified blood pressure into 7 categories.^[2] This classification remained unchanged in the 2013 ESH/ESC classification.^[3] The ESH/ESC classification excludes JNC 7’s pre-hypertension category, but includes 3 different grades of hypertension in contrast to JNC 7’s two-stage classification of hypertension.

Classification

JNC 8 update on JNC 7 Classification of Blood Pressure

JNC8(2014) proposes no changes in the blood pressure classification given in JNC7(2004). According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure^[4] blood pressure values were classified as follows:

**Blood Pressure Classification**
Category	Systolic (mmHg)		Diastolic (mmHg)
Normal	< 120	and	< 80
Pre-Hypertension	120-139	or	80-89
Stage 1 Hypertension	140-159	or	90-99
Stage 2 Hypertension	>160	or	>100

ESH/ESC Classification of Blood Pressure

In Europe, a different classification of blood pressure was introduced in 2007 by The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). According to the 2013 Guidelines for the Management of Arterial Hypertension, blood pressure values were classified as follows: ^[2]

**Blood Pressure Classification**
Category	Systolic (mmHg)		Diastolic (mmHg)
Optimal	< 120	and	< 80
Normal	120-129	and/or	80-84
High Normal	130-139	and/or	85-89
Grade 1 Hypertension	140-159	and/or	90-99
Grade 2 Hypertension	160-179	and/or	100-109
Grade 3 Hypertension	≥ 180	and/or	≥110
Isolated Systolic Hypertension	≥140	and	<90

2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults (JNC 8) -- DO NOT EDIT

**Comparison of Current Recommendations With JNC 7 Guidelines**
Topic	JNC 7	2014 Hypertension Guideline (JNC8)
Methodology	Nonsystematic literature review by expert committee including a range of study designs Recommendations based on consensus	Critical questions and review criteria defined by expert panel with input from methodology team Initial systematic review by methodologists restricted to RCT evidence Subsequent review of RCT evidence and recommendations by the panel according to a standardized protocol
Definitions	Defined hypertension and prehypertension	Definitions of hypertension and prehypertension not addressed, but thresholds for pharmacologic treatment were defined
Treatment goals	Separate treatment goals defined for “uncomplicated” hypertension and for subsets with various comorbid conditions (diabetes and CKD)	Similar treatment goals defined for all hypertensive populations except when evidence review supports different goals for a particular subpopulation
Lifestyle recommendations	Recommended lifestyle modifications based on literature review and expert opinion	Lifestyle modifications recommended by endorsing the evidencebased Recommendations of the Lifestyle Work Group
Drug therapy	Recommended 5 classes to be considered as initial therapy but recommended thiazide-type diuretics as initial therapy for most patients without compelling indication for another class Specified particular antihypertensive medication classes for patients with compelling indications, ie, diabetes, CKD, heart failure, myocardial infarction, stroke, and high CVD risk Included a comprehensive table of oral antihypertensive drugs including names and usual dose ranges	Recommended selection among 4 specific medication classes (ACEI or ARB, CCB or diuretics) and doses based on RCT evidence Recommended specific medication classes based on evidence review for racial, CKD, and diabetic subgroups Panel created a table of drugs and doses used in the outcome trials
Scope of topics	Addressed multiple issues (blood pressure measurement methods, patient evaluation components, secondary hypertension, adherence to regimens, resistant hypertension, and hypertension in special populations) based on literature review and expert opinion	Evidence review of RCTs addressed a limited number of questions, those judged by the panel to be of highest priority.
Pre-publication review	Reviewed by the National High Blood Pressure Education Program Coordinating Committee, a coalition of 39 major professional, public, and voluntary organizations and 7 federal agencies	Reviewed by experts including those affiliated with professional and public organizations and federal agencies; no official sponsorship by any organization should be inferred

Abbreviations:

ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CCB, calcium channel blocker; CKD, chronic kidney disease; CVD, cardiovascular disease; JNC, Joint National Committee;

RCT, randomized controlled trial.

Adopted from 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8).^[5]

References

↑ Cuddy ML (2005). "Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1)". J Pract Nurs. 55 (4): 17–21, quiz 22-3. PMID 16512265.
↑ ^2.0 ^2.1 Bonny A, Lacombe F, Yitemben M, Discazeaux B, Donetti J, Fahri P; et al. (2008). "The 2007 ESH/ESC guidelines for the management of arterial hypertension". J Hypertens. 26 (4): 825, author reply 825-6. doi:10.1097/HJH.0b013e3282f857e7. PMID 18327095.
↑ Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M; et al. (2013). "2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". J Hypertens. 31 (7): 1281–357. doi:10.1097/01.hjh.0000431740.32696.cc. PMID 23817082.
↑ Chobanian AV; 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: 2560–72. PMID 12748199.
↑ James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J; et al. (2014). "2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)". JAMA. 311 (5): 507–20. doi:10.1001/jama.2013.284427. PMID 24352797.

Template:WH Template:WS

[pmid16512265-1] Cuddy ML (2005). "Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1)". J Pract Nurs. 55 (4): 17–21, quiz 22-3. PMID 16512265.

[pmid18327095-2] 2.0 ^2.1 Bonny A, Lacombe F, Yitemben M, Discazeaux B, Donetti J, Fahri P; et al. (2008). "The 2007 ESH/ESC guidelines for the management of arterial hypertension". J Hypertens. 26 (4): 825, author reply 825-6. doi:10.1097/HJH.0b013e3282f857e7. PMID 18327095.

[pmid23817082-3] Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M; et al. (2013). "2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". J Hypertens. 31 (7): 1281–357. doi:10.1097/01.hjh.0000431740.32696.cc. PMID 23817082.

[jnc7-4] Chobanian AV; 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: 2560–72. PMID 12748199.

[pmid24352797-5] James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J; et al. (2014). "2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)". JAMA. 311 (5): 507–20. doi:10.1001/jama.2013.284427. PMID 24352797.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Template:Hypertension}}
+{{Chronic hypertension}}
-{{CMG}}; '''Assistant Editor-In-Chief:''' Taylor Palmieri, [[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]]
+{{CMG}}; '''Assistant Editor-In-Chief:''' [[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]], {{USAMA}}
 ==Overview==
-[[Blood pressure]] values for adults have been classified in 2004 according to the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure into normal, prehypertension, stage 1 hypertension and stage 2 hypertension<ref name="pmid16512265">{{cite journal| author=Cuddy ML| title=Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1). | journal=J Pract Nurs | year= 2005 | volume= 55 | issue= 4 | pages= 17-21; quiz 22-3 | pmid=16512265 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16512265  }} </ref>. In Europe, a different classification of blood pressure has been conducted in 2007 by “The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)”<ref name="pmid18327095">{{cite journal| author=Bonny A, Lacombe F, Yitemben M, Discazeaux B, Donetti J, Fahri P et al.| title=The 2007 ESH/ESC guidelines for the management of arterial hypertension. | journal=J Hypertens | year= 2008 | volume= 26 | issue= 4 | pages= 825; author reply 825-6 | pmid=18327095 | doi=10.1097/HJH.0b013e3282f857e7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18327095  }} </ref>. The classification excludes JNC 7’s pre-hypertension category, but includes 3 different grades of hypertension, in contrast to JNC 7’s two-stage classification of hypertension.
+In 2004, the Seventh Report of the Joint National Committee (JNC 7) classified blood pressure values into 4 categories: normal, prehypertension, stage I hypertension, and stage II hypertension.<ref name="pmid16512265">{{cite journal| author=Cuddy ML| title=Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1). | journal=J Pract Nurs | year= 2005 | volume= 55 | issue= 4 | pages= 17-21; quiz 22-3 | pmid=16512265 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16512265 }} </ref> In 2007, the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) classified blood pressure into 7 categories.<ref name="pmid18327095">{{cite journal| author=Bonny A, Lacombe F, Yitemben M, Discazeaux B, Donetti J, Fahri P et al.| title=The 2007 ESH/ESC guidelines for the management of arterial hypertension. | journal=J Hypertens | year= 2008 | volume= 26 | issue= 4 |pages= 825; author reply 825-6 | pmid=18327095 | doi=10.1097/HJH.0b013e3282f857e7 |pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18327095 }} </ref> This classification remained unchanged in the 2013 ESH/ESC classification.<ref name="pmid23817082">{{cite journal| author=Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M et al.| title=2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). | journal=J Hypertens | year= 2013 | volume= 31 | issue= 7 | pages= 1281-357 | pmid=23817082 | doi=10.1097/01.hjh.0000431740.32696.cc | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23817082 }} </ref> The ESH/ESC classification excludes JNC 7’s pre-hypertension category, but includes 3 different grades of hypertension in contrast to JNC 7’s two-stage classification of hypertension.
 ==Classification==
-===JNC 7 Classification of Blood Pressure or Adults===
+===JNC 8 update on JNC 7 Classification of Blood Pressure===
-The ''Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure''<ref name="jnc7">{{
+JNC8(2014) proposes no changes in the blood pressure classification given in JNC7(2004). According to the ''Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure''<ref name="jnc7">{{
 cite journal
 |url=http://jama.ama-assn.org/cgi/content/full/289.19.2560v1
@@ Line 19: / Line 19: @@
 |pages = 2560-72
 |pmid = 12748199
-}}</ref> has classified blood pressure as the following:
+}}</ref> blood pressure values were classified as follows:
-{| class="wikitable" border="1" style="background:FloralWhite"
+{| border="0" style="border-collapse:collapse; text-align:center; font-size:120%;" cellpadding="5" align="center" width="600px"
 |-
-| '''Blood Pressure Classification''' || '''Systolic''' (mm Hg) || || '''Diastolic''' (mm Hg)
+| align="center" style="background:#4479BA; color: #FFFFFF;" |Category
+| align="center" style="background:#4479BA; color: #FFFFFF;" |Systolic (mmHg)
+| align="center" style="background:#4479BA; color: #FFFFFF;" |
+| align="center" style="background:#4479BA; color: #FFFFFF;" |Diastolic (mmHg)
+|+ align="center" style="background:#4479BA; color: #FFFFFF;" |'''Blood Pressure Classification'''
 |-
-| '''Normal''' || < 120 || and ||< 80
+|bgcolor="#f3f3f3"|Normal|| < 120 || and ||< 80
 |-
-| '''Pre-Hypertension''' || 120-139 || or || 80-89
+|bgcolor="#f3f3f3"|Pre-Hypertension|| 120-139 || or || 80-89
 |-
-| '''Stage 1 Hypertension''' || 140-159 || or || 90-99
+|bgcolor="#f3f3f3"|Stage 1 Hypertension|| 140-159 || or || 90-99
 |-
-| '''Stage 2 Hypertension''' || >160 || or || <u>></u>100
+|bgcolor="#f3f3f3"|Stage 2 Hypertension|| >160 || or || <u>></u>100
 |}
-===European Classification of Blood Pressure===
+===ESH/ESC Classification of Blood Pressure===
-In Europe, a different classification of blood pressure has been conducted in 2007 by ''The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)''. According             to the 2007 Guidelines for the Management of Arterial Hypertension, the blood pressure classification is as follows:
+In Europe, a different classification of blood pressure was introduced in 2007 by ''The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)''. According to the 2013 Guidelines for the Management of Arterial Hypertension, blood pressure values were classified as follows:
 <ref name="pmid18327095">{{cite journal| author=Bonny A, Lacombe F, Yitemben M, Discazeaux B, Donetti J, Fahri P et al.| title=The 2007 ESH/ESC guidelines for the management of arterial hypertension. | journal=J Hypertens | year= 2008 | volume= 26 | issue= 4 | pages= 825; author reply 825-6 | pmid=18327095 | doi=10.1097/HJH.0b013e3282f857e7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18327095  }} </ref>
-{| class="wikitable" border="1" style="background:FloralWhite"
+{| border="0" style="border-collapse:collapse; text-align:center; font-size:120%;" cellpadding="5" align="center" width="600px"
 |-
-| '''Blood Pressure Classification''' || '''Systolic''' (mm Hg) || || '''Diastolic''' (mm Hg)
+| align="center" style="background:#4479BA; color: #FFFFFF;" |Category
+| align="center" style="background:#4479BA; color: #FFFFFF;" |Systolic (mmHg)
+| align="center" style="background:#4479BA; color: #FFFFFF;" |
+| align="center" style="background:#4479BA; color: #FFFFFF;" |Diastolic (mmHg)
+|+ align="center" style="background:#4479BA; color: #FFFFFF;" |'''Blood Pressure Classification'''
 |-
-| '''Optimal''' || < 120 || and ||< 80
+|bgcolor="#f3f3f3"|Optimal|| < 120 || and ||< 80
 |-
-| '''Normal''' || 120-129 || and/or || 80-84
+|bgcolor="#f3f3f3"|Normal|| 120-129 || and/or || 80-84
 |-
-| '''High Normal''' || 130-139 || and/or || 85-89
+|bgcolor="#f3f3f3"|High Normal|| 130-139 || and/or || 85-89
 |-
-| '''Grade 1 Hypertension''' || 140-159 || and/or || 90-99
+|bgcolor="#f3f3f3"|Grade 1 Hypertension|| 140-159 || and/or || 90-99
 |-
-| '''Grade 2 Hypertension''' || 160- 179 || and/or || 100-109
+|bgcolor="#f3f3f3"|Grade 2 Hypertension|| 160-179 || and/or || 100-109
 |-
-| '''Grade 3 Hypertension''' ||                   ≥     180 || and/or ||                   ≥     110
+|bgcolor="#f3f3f3"|Grade 3 Hypertension|| ≥ 180 || and/or || ≥110
 |-
-| '''Isolated Systolic Hypertension''' ||                   ≥     140 || and || <90
+|bgcolor="#f3f3f3"|Isolated Systolic Hypertension|| ≥140 || and || <90
 |-
 |}
-===Classification of Pathophysiology===
+===2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults (JNC 8) --''' DO NOT EDIT'''===
-Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes.
+{| align=center
-* Over 90% of adult hypertension has no clear cause and is therefore called essential/primary hypertension.  Often, it is part of the [[metabolic syndrome|metabolic "syndrome X"]] in patients with [[insulin resistance]]: it occurs in combination with [[diabetes mellitus]] (type 2), [[combined hyperlipidemia]] and [[central obesity]].<ref name="pmid16719248">{{cite journal | author = Luma GB, Spiotta RT | title = Hypertension in children and adolescents. | journal = Am Fam Physician | volume = 73 | issue = 9 | pages = 1558-68 | month = may | year = 2006 | id = PMID 16719248}}</ref>
+|-
-* [[Secondary hypertension]] is more common in pre-adolescent children, with most cases caused by [[renal disease]].
+|
-====Essential Hypertension====
+{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
-Essential hypertension is the most prevalent type of hypertension type, and affects 90-95% of hypertensive patients. Although there are risk factors for essential hypertension (sedentary lifestyle, [[obesity]], increased salt intake, increased [[alcohol]] intake), by definition there is no other disease state responsible for the occurrence of the elevated blood pressure.
+|+ align="center" style="background:#4479BA; color: #FFFFFF;" |'''Comparison of Current Recommendations With JNC 7 Guidelines'''
+|-
+| align="center" style="background:#DCDCDC;" | '''Topic'''
+! colspan="3" align="center" style="background:#DCDCDC;" | JNC 7
+! colspan="4" align="center" style="background:#DCDCDC;" |2014 Hypertension Guideline (JNC8)
+|-
+|align="left" style="background:#DCDCDC;"|'''Methodology'''
+| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="left" | Nonsystematic literature review by expert committee including a
+range of study designs
+Recommendations based on consensus
+| colspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" | Critical questions and review criteria defined by expert panel with
+input from methodology team
+Initial systematic review by methodologists restricted to RCT
+evidence
+Subsequent review of RCT evidence and recommendations by the
+panel according to a standardized protocol
+|-
+|align="left" style="background:#DCDCDC;"|'''Definitions'''
+| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Defined hypertension and prehypertension
+| colspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Definitions of hypertension and prehypertension not addressed,
+but thresholds for pharmacologic treatment were defined
+|-
+|align="left" style="background:#DCDCDC;"|'''Treatment goals'''
+| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="left" | Separate treatment goals defined for “uncomplicated” hypertension
+and for subsets with various comorbid conditions
+(diabetes and CKD)
+| colspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" | Similar treatment goals defined for all hypertensive populations
+except when evidence review supports different goals for a particular
+subpopulation
+|-
+|align="left" style="background:#DCDCDC;"|'''Lifestyle recommendations'''
+| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Recommended lifestyle modifications based on literature review and
+expert opinion
+| colspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Lifestyle modifications recommended by endorsing the evidencebased
+Recommendations of the Lifestyle Work Group
+|-
+|align="left" style="background:#DCDCDC;"|'''Drug therapy'''
+| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Recommended 5 classes to be considered as initial therapy but recommended
+thiazide-type diuretics as initial therapy for most patients
+without compelling indication for another class
+Specified particular antihypertensive medication classes for patients
+with compelling indications, ie, diabetes, CKD, heart failure, myocardial
+infarction, stroke, and high CVD risk
+Included a comprehensive table of oral antihypertensive drugs including
+names and usual dose ranges
+| colspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" | Recommended selection among 4 specific medication classes (ACEI
+or ARB, CCB or diuretics) and doses based on RCT evidence
+Recommended specific medication classes based on evidence review
+for racial, CKD, and diabetic subgroups
+Panel created a table of drugs and doses used in the outcome trials
+|-
+|align="left" style="background:#DCDCDC;"|'''Scope of topics'''
+| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Addressed multiple issues (blood pressure measurement methods,
+patient evaluation components, secondary hypertension, adherence
+to regimens, resistant hypertension, and hypertension in special
+populations) based on literature review and expert opinion
+| colspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Evidence review of RCTs addressed a limited number of questions,
+those judged by the panel to be of highest priority.
+|-
+|align="left" style="background:#DCDCDC;"|'''Pre-publication review'''
+| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Reviewed by the National High Blood Pressure Education Program
+Coordinating Committee, a coalition of 39 major professional, public,
+and voluntary organizations and 7 federal agencies
+| colspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Reviewed by experts including those affiliated with professional and
+public organizations and federal agencies; no official sponsorship by
+any organization should be inferred
+|-
+|}
+|}
+<small><small>'''Abbreviations:'''
+ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CCB, calcium channel blocker; CKD, chronic kidney disease; CVD, cardiovascular disease; JNC, Joint National Committee;
+RCT, randomized controlled trial.
-====Secondary Hypertension====
+Adopted from 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8).<ref name="pmid24352797">{{cite journal| author=James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al.| title=2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). | journal=JAMA | year= 2014 | volume= 311 | issue= 5 | pages= 507-20 | pmid=24352797 | doi=10.1001/jama.2013.284427 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24352797  }} </ref></small></small>
-Secondary hypertension results from an identifiable cause.  Recognition of secondary hypertension is critical since the management is different than primary or essential hypertension and involves treatment of the underlying cause of the elevated blood pressure. Underlying disorders that account for secondary hypertension include:
 ==References==