Adapted from Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII). JAMA 2003;289:2560–2572.
Table 9.5 Laboratory Tests and Procedures Recommended in the Evaluation of Uncomplicated Hypertensiona
Lipid profile that includes HDL, LDL, and triglycerides after a 9-to 12-hour fast
HDL, high-density lipoprotein; LDL, low-density lipoprotein. aIf any of the above are abnormal, consultation or referral to an internist is indicated. Adapted from Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII). JAMA 2003;289:2560–2572.
More than 95% of individuals with hypertension have primary or essential hypertension (cause unknown), whereas fewer than 5% have secondary hypertension resulting from another disorder. Key factors to be determined in the history and physical examination include presence of prior elevated readings, previous use of antihypertensive agents, a family history of cardiovascular death before age 55, and excessive intake of alcohol or sodium. Lifestyle modification is considered important in the therapy of hypertension; thus, a detailed history of diet and physical activity should be obtained (14). Baseline laboratory evaluations to rule out reversible causes of hypertension (secondary hypertension) are listed in Table 9.5. Diagnosis and management are based on the classification of blood pressure readings, as presented in Table 9.6.
The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) released their seventh report in 2003. The purpose was to provide an evidence-based approach to the prevention and management of hypertension. Following are key points of this report:
Systolic blood pressure in those older than 50 years is a more important cardiovascular risk factor than diastolic blood pressure.
Beginning at 115/75 mm Hg, the risk of cardiovascular disease doubles for each increment of 20/10 mm Hg.
Individuals who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension.
Patients with prehypertension (systolic blood pressure 120–139 mm Hg or diastolic blood pressure 80–89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and cardiovascular disease.
For uncomplicated hypertension, thiazide diuretic should be used in most cases for medical treatment, either alone or combined with drugs from other classes.
Table 9.6 Blood Pressure (BP) Classification (Adults 18 Years and Older)
Modified from Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII). JAMA 2003;289:2560–2572.
Table 9.7 Drug Choices for Hypertension with Compelling Indications
ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; CCB, calcium channel blocker; MI, myocardial infarction. Adapted from Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII). JAMA 2003;289:2560–2572.