Chronic hypertension classification: Difference between revisions
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==Overview== | ==Overview== | ||
The Joint National Committee seventh report (JNC 7) defines hypertension as a [[systolic blood pressure]] of over 140 mm Hg or a [[diastolic blood pressure]] greater than 90 mm Hg based upon the average of two or more properly measured readings at each of two or more visits after an initial screen<ref name="pmid12748199">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL 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 | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12748199 }} </ref>. | The Joint National Committee seventh report (JNC 7) defines hypertension as a [[systolic blood pressure]] of over 140 mm Hg or a [[diastolic blood pressure]] greater than 90 mm Hg based upon the average of two or more properly measured readings at each of two or more visits after an initial screen<ref name="pmid12748199">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL 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 | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12748199 }} </ref>. | ||
==Classification== | |||
==JNC Classification of Severity== | ===JNC Classification of Severity=== | ||
The ''Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure''<ref name="jnc7">{{ | The ''Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure''<ref name="jnc7">{{ | ||
cite journal | cite journal | ||
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|pmid = 12748199 | |pmid = 12748199 | ||
}}</ref> has classified blood pressure in the follows: | }}</ref> has classified blood pressure in the follows: | ||
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Pre-hypertension is not a disease category; rather, it is a designation chosen to identify individuals at high risk of developing hypertension. It is not clear if treatment of pre-hypertension would improve outcomes. In patients with [[diabetes mellitus]] or [[Nephropathy|kidney disease]], a blood pressure > 130/80 mmHg should be considered elevated and may warrant treatment. | Pre-hypertension is not a disease category; rather, it is a designation chosen to identify individuals at high risk of developing hypertension. It is not clear if treatment of pre-hypertension would improve outcomes. In patients with [[diabetes mellitus]] or [[Nephropathy|kidney disease]], a blood pressure > 130/80 mmHg should be considered elevated and may warrant treatment. | ||
==Classification of Pathophysiology== | ===Classification of Pathophysiology=== | ||
Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes. | Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes. | ||
* 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> | * 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]]. | * [[Secondary hypertension]] is more common in pre-adolescent children, with most cases caused by [[renal disease]]. | ||
====Essential Hypertension==== | |||
===Essential Hypertension=== | |||
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 defintion there is no other disease state responsible for the occurrence of the elevated blood pressure. | 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 defintion there is no other disease state responsible for the occurrence of the elevated blood pressure. | ||
====Secondary Hypertension==== | |||
===Secondary | |||
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: | 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: | ||
Revision as of 03:09, 4 March 2013
|
Hypertension Main page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Taylor Palmieri
Overview
The Joint National Committee seventh report (JNC 7) defines hypertension as a systolic blood pressure of over 140 mm Hg or a diastolic blood pressure greater than 90 mm Hg based upon the average of two or more properly measured readings at each of two or more visits after an initial screen[1].
Classification
JNC Classification of Severity
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure[2] has classified blood pressure in the follows:
| Blood Pressure Classification | Systolic (mm Hg) | Diastolic (mm Hg) | |
| 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 |
Pre-hypertension is not a disease category; rather, it is a designation chosen to identify individuals at high risk of developing hypertension. It is not clear if treatment of pre-hypertension would improve outcomes. In patients with diabetes mellitus or kidney disease, a blood pressure > 130/80 mmHg should be considered elevated and may warrant treatment.
Classification of Pathophysiology
Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes.
- Over 90% of adult hypertension has no clear cause and is therefore called essential/primary hypertension. Often, it is part of the metabolic "syndrome X" in patients with insulin resistance: it occurs in combination with diabetes mellitus (type 2), combined hyperlipidemia and central obesity.[3]
- Secondary hypertension is more common in pre-adolescent children, with most cases caused by renal disease.
Essential Hypertension
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 defintion there is no other disease state responsible for the occurrence of the elevated blood pressure.
Secondary Hypertension
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
- ↑ Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL; 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.
- ↑ 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.
- ↑ Luma GB, Spiotta RT (2006). "Hypertension in children and adolescents". Am Fam Physician. 73 (9): 1558–68. PMID 16719248. Unknown parameter
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