THE FORUM

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HYPERTENSION

Hypertension


Evaluation & Treatment


  • The treatment of hypertension is the most common reason for office visits
  • 30 % of adults in the United States have hypertension,
  • 48 % of patients BP is not controlled




Definition:


  • Normal blood pressure: systolic <120 mmHg and diastolic <80 mmHg
  • Prehypertension: systolic 120 to 139 mmHg or diastolic 80 to 89 mmHg
  • Hypertension:
  • Stage 1: systolic 140 to 159 mmHg or diastolic 90 to 99 mmHg
  • Stage 2: systolic ≥160 or diastolic ≥100 mmHg


PRIMARY (ESSENTIAL) HYPERTENSION


Risk factors:


  • Family History
  • Excess sodium intake
  • Obesity
  • Physical inactivity
  • Dyslipidemia
  • Vitamin D deficiency


Complications :


  • Premature cardiovascular disease
  • risk of heart failure,
  • Left ventricular hypertrophy ,
  • Ischemic stroke
  • Subarachnoid or Intracerebral hemorrhage
  • End-stage renal disease
  • Aortic Dissection
  • Malignant Hypertension


USPSTF: guidelines for blood pressure screening


  1. Every two years for persons with systolic and diastolic pressures below 120 mmHg and 80 mmHg
  2. Yearly for persons with a systolic pressure of 120 to 139 mmHg or a diastolic pressure of 80 to 89 mmHg
  3. In the absence of end-organ damage, the diagnosis of mild hypertension should not be made until the blood pressure has been measured on at least three to six visits, spaced over a period of weeks to month
  4. Approximately 20 to 25 percent of patients with stage 1 office hypertension have "white coat" or isolated office hypertension


History & Physical examination

  • Evaluate for signs of end-organ damage such as retinopathy
  • Look for evidence of a cause of secondary hypertension.


Laboratory testing

  • Hematocrit, urinalysis, routine blood chemistries.
  • Lipid profile (total and HDL-cholesterol, triglycerides)
  • EKG
  • Echocardiography is indicated to detect possible end-organ damage in a patient with borderline blood pressure values.


Treatment


BY


Shameela Farooqui MD.

Diplomat American Board Of Internal Medicine

Consultant @ KFSH&RC