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== Other Resources (Podcasts, Blog Posts, Videos) == |
== Other Resources (Podcasts, Blog Posts, Videos) == |
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== Testing == |
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Revision as of 03:48, 28 October 2017
Over one-third of adults in the United States aged 20 years and older have hypertension and over 40 million physician office visits with a primary diagnosis of hypertension occur each year.[1] Total costs associated with high blood pressure in 2011 in the US were $46 billion in health care services, medications, and missed days of work.[2]
Definition
JNC 8 guidelines: Goal blood pressure of SBP < 140 and DBP < 90 for all age groups and co-morbidities except age > 60. For age > 60, goal blood pressure is SBP < 150 and DBP < 90.
The SPRINT trial: Intensive blood pressure control (SBP < 120) improved CV outcomes and overall survival while modestly increasing the risk of some serious adverse events. [ Journal Club ] [ NEJM Trial Video ]
Hypertensive urgency
Hypertensive urgency is usually defined as SBP > 180 and DBP > 110 without symptoms. Asymptomatic hypertensive urgency does not require ED treatment.[3]
Hypertensive emergency
Hypertensive emergency is defined as elevated blood pressure (SBP > 180, DBP >110) with evidence of end-organ damage (e.g. ACS, encephalopathy, ARF, PRES). This requires immediate treatment in the Emergency Department.
Rationale for Treatment
Every 5mm Hg increase in DBP and every 10mm Hg increase in SBP is associated with a 28% increase in the risk of death from coronary heart disease.[4] A 10mm Hg drop in SBP and 5mm Hg drop in DBP was associated with 25% fall in cardiovascular disease, 25% reduction in CHF, and 33% reduction of strokes. [5][6]
Etiology
Essential hypertension
Etiology typically multifactoral: autonomic nervous system, the renin-angiontensin-aldosterone system, sodium-potassium ratios, and socioeconomic factors including stress.
Secondary hypertension
Common causes typically include known secondary causes such as chronic kidney disease, pheochromocytoma, hyperaldosteronism, hyperparathyroidism, drug-induced, as well as others
Reliability of Blood Pressure Readings
Diagnosis and Work-up
Treatment
Lifestyle changes
Pharmacotherapy
Other Pearls
Trial Summaries
Other Resources (Podcasts, Blog Posts, Videos)
Testing
Sub-heading 1
Sub-heading 2
Sub-heading 3
- ^
{{cite journal}}: Empty citation (help) - ^ vv.
{{cite journal}}: Cite journal requires|journal=(help); Missing or empty|title=(help) - ^ – via Patel KK, Young L, Howell EH, Hu B, Rutecki G, Thomas G, et al. Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting. JAMA Intern Med. American Medical Association; 2016;176: 981–988.
{{cite journal}}: Cite journal requires|journal=(help); Missing or empty|title=(help) - ^ van den Hoogen, P. C.; Feskens, E. J.; Nagelkerke, N. J.; Menotti, A.; Nissinen, A.; Kromhout, D. (2000-01-06). "The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group". The New England Journal of Medicine. 342 (1): 1–8. doi:10.1056/NEJM200001063420101. ISSN 0028-4793. PMID 10620642.
- ^ Law, M. R.; Morris, J. K.; Wald, N. J. (2009-05-19). "Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies". BMJ. 338: b1665. doi:10.1136/bmj.b1665. ISSN 0959-8138. PMID 19454737.
- ^ Blood Pressure Lowering Treatment Trialists' Collaboration (2014-08-16). "Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data". Lancet (London, England). 384 (9943): 591–598. doi:10.1016/S0140-6736(14)61212-5. ISSN 1474-547X. PMID 25131978.