Chronic hypertension screening
|
Hypertension Main page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
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]. The Systematic Review of Guidelines on Cardiovascular Risk Assessment in 2010 noted two hypertension screening guidelines for adults published by the U.S. Preventive Services Task Force (USPSTF) and American Heart Association (AHA).[2]
Screening
U.S. Preventive Services Task Force (USPSTF) (Ref: 20065196) and JNC 7 (Ref: 16512265) recommendations for hypertension screening:
Screening is recommended every 2 years if BP < 120/80 mmHg
Screening is recommended yearly if initial blood pressure screening revealed JNC 7’s pre-hypertension stage: SBP 120-139 mmHg and/or DBP 80-99 mmHg.
Confirmation of BP values within 2 months is required if initial blood pressure revealed JNC 7’s stage 1 hypertension.
Evaluation or referral to source of care within 1 month if initial blood pressure revealed JNC 7’s stage 2 hypertension.
Evaluation and treatment immediately or within 1 week if initial blood pressure revealed JNC 7’s stage 2 hypertension with BP > 180/110 mmHg. Clinical situation and complications are to be taken into major consideration.
Treatment may be initiated immediately at lower BP values in specific populations, such as those known to have Diabetes Mellitus.
Screening Test[1]
| Diagnosis | Diagnostic Tests |
| Chronic kidney disease | Estimate GFR |
| Coarctation of aorta | CT angiography |
| Cushing's syndrome and other glucocorticoid excess states including chronic steroid therapy | History; dexamethasone suppression test |
| Drug induced/related | History; drug screening |
| Pheochromocytoma | 24 hour urinary metanephrine and normetanephrine |
| Primary aldosteronism and other mineralocorticoid 24-hour urinary aldosterone level or excess states | 24-hour urinary aldosterone level or specific measurements of other mineralocorticoids |
| Renovascular hypertension | Doppler flow study; magnetic resonance angiography |
| Sleep apnea | Sleep study with O2 saturation |
| Thyroid/ Parathyroid disease | TSH; serum PTH |
References
- ↑ 1.0 1.1 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.
- ↑ Ferket BS, Colkesen EB, Visser JJ, Spronk S, Kraaijenhagen RA, Steyerberg EW; et al. (2010). "Systematic review of guidelines on cardiovascular risk assessment: Which recommendations should clinicians follow for a cardiovascular health check?". Arch Intern Med. 170 (1): 27–40. doi:10.1001/archinternmed.2009.434. PMID 20065196.