Chronic hypertension resident survival guide: Difference between revisions
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Shown below is an algorithm summarizing the diagnosis of | Shown below is an algorithm summarizing the diagnosis of | ||
==General Approach to Suspected Hypertension== | |||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | {{familytree | | | | | A01 | |A01='''Suspected hypertension<br>BP > 140/90 mmHg'''}} | ||
{{familytree | | | | | | | | {{familytree | | | | | |!| | |}} | ||
{{familytree | {{familytree | | | | | B01 | |B01=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Blood pressure measurement'''<br> | ||
Before taking the BP | Before taking the BP | ||
:❑ Sit patient quietly in a chair for 5 mins<br> | :❑ Sit patient quietly in a chair for 5 mins<br> | ||
Line 43: | Line 43: | ||
</div><br> | </div><br> | ||
Click '''[[Hypertension blood pressure measurement|here for more information regarding blood pressure measurement]]'''}} | Click '''[[Hypertension blood pressure measurement|here for more information regarding blood pressure measurement]]'''}} | ||
{{familytree | | | | | |,|-|^|-|.| | |}} | {{familytree | | | | | |!| | |}} | ||
{{familytree | | | | | | {{familytree | | | | | C01 | | C01=Office BP >140/90 mmHg on 2-3 visits}} | ||
{{familytree | | | | | | | {{familytree | | | | | |!| | |}} | ||
{{familytree | | | | | | {{familytree | | | | | D01 | | | | D01=Does the patient have any evidence of target organ damage, DM, or CKD?}} | ||
{{familytree | |,|-|-|-|+|-|-|-|.| |}} | {{familytree | | | |,|-|^|-|.| | |}} | ||
{{familytree | | {{familytree | | | E01 | | E02 | | E01=Yes|E02=No}} | ||
{{familytree | |!| | | |!| | | |! | {{familytree | | | |!| | | |!| | | | |}} | ||
{{familytree | | {{familytree | | | F01 | | F02 | | | | |F01=Proceed to '''[[hypertensive crisis resident survival guide]]'''|F02=Perform home BP/out-of-office monitoring}} | ||
{{familytree | | | | | | | |!| | | | | | |}} | |||
{{familytree | | | | | | | G01 | | | | |G01=Is the average home BP measurement <140/90?}} | |||
{{familytree | | | |,|-|-|-|+|-|-|-|.| |}} | |||
{{familytree | | | H01 | | H02 | | H03 | |H01=Yes|H02=Inconclusive|H03=No}} | |||
{{familytree | | | |!| | | |!| | | |!| | |}} | |||
{{familytree | | | |!| | | I01 | | |!| | |I01=Perform 24-hour ABPM}} | |||
{{familytree | | | |!| | | |!| | | |!| | |}} | |||
{{familytree | | | |!| | | J01 | | |!| | |J01=Is the 24-hour ABPM ≤135/85?}} | |||
{{familytree | | | |!| |,|-|^|-|.| |!| | |}} | |||
{{familytree | K01 |^| K02 | | K03 |^| K04 | | K01=White-coat hypertension confirmed|K02=Yes|K03=No|K04=Hypertension confirmed}} | |||
{{familytree | |!| | | | | | | | | | | |!| | | | |}} | |||
{{familytree | L01 | | | | | | | | | | L02 | | |L01=<div style="float: left; text-align: left; width: 15em; padding:1em;">❑ Continue BP monitoring<br>❑ Follow-up appointment in ....</div>|L02=Classify the patient<br> based on the BP reading}} | |||
{{familytree | | | | | | | | | |,|-|-|-|+|-|-|-|.| | |}} | |||
{{familytree | | | | | | | | | M01 | | M02 | | M03 | |M01=SBP 120-139 mmHg<br>DBP - 80-89 mmHg|M02=SBP 149-159 mmHg<br>DBP 90-99 mmHg|M03=SBP >160 mmHg<br>DBP >110 mmHg}} | |||
{{familytree | | | | | | | | | |!| | | |!| | | |!| |}} | |||
{{familytree | | | | | | | | | N01 | | N02 | | N03 | |N01=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Prehypertension'''</div>|N02=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Stage 1 hypertension'''</div><br>Proceed to [[Hypertension resident survival guide#Complete Diagnostic Approach|'''complete diagnostic approach''']]|N03=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Stage 2 hypertension'''<br></div> | |||
Proceed to '''[[hypertensive crisis resident survival guide]]'''}} | Proceed to '''[[hypertensive crisis resident survival guide]]'''}} | ||
{{familytree | {{familytree | | | | | | | | | | | | | |!| | | | | }} | ||
{{familytree | | {{familytree | | | | | | | | | | | | | O01 | |O01=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Determine who to treat based on the following:'''</div>}} | ||
'' | |||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 18:38, 17 April 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]
Overview
Classification
Classification | Blood pressure (mmHg) |
---|---|
Normal | < 120/80 |
Prehypertension | 120-139/80-89 |
Stage 1 hypertension | 140-159/90-99 |
Stage 2 hypertension | ≥ 160/110 |
Isolated systolic hypertension | |
Isolated diastolic hypertension |
Causes
Life Threatening Causes
Common Causes
Diagnosis
Shown below is an algorithm summarizing the diagnosis of
General Approach to Suspected Hypertension
Suspected hypertension BP > 140/90 mmHg | |||||||||||||||||||||||||||||||||||||||||
Blood pressure measurement Before taking the BP
❑ Take 2 readings and find the average Click here for more information regarding blood pressure measurement | |||||||||||||||||||||||||||||||||||||||||
Office BP >140/90 mmHg on 2-3 visits | |||||||||||||||||||||||||||||||||||||||||
Does the patient have any evidence of target organ damage, DM, or CKD? | |||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||
Proceed to hypertensive crisis resident survival guide | Perform home BP/out-of-office monitoring | ||||||||||||||||||||||||||||||||||||||||
Is the average home BP measurement <140/90? | |||||||||||||||||||||||||||||||||||||||||
Yes | Inconclusive | No | |||||||||||||||||||||||||||||||||||||||
Perform 24-hour ABPM | |||||||||||||||||||||||||||||||||||||||||
Is the 24-hour ABPM ≤135/85? | |||||||||||||||||||||||||||||||||||||||||
White-coat hypertension confirmed | Yes | No | Hypertension confirmed | ||||||||||||||||||||||||||||||||||||||
❑ Continue BP monitoring ❑ Follow-up appointment in .... | Classify the patient based on the BP reading | ||||||||||||||||||||||||||||||||||||||||
SBP 120-139 mmHg DBP - 80-89 mmHg | SBP 149-159 mmHg DBP 90-99 mmHg | SBP >160 mmHg DBP >110 mmHg | |||||||||||||||||||||||||||||||||||||||
Prehypertension | Stage 1 hypertension Proceed to complete diagnostic approach | Stage 2 hypertension
Proceed to hypertensive crisis resident survival guide | |||||||||||||||||||||||||||||||||||||||
Determine who to treat based on the following: | |||||||||||||||||||||||||||||||||||||||||
Complete Diagnostic Approach
Obtain a detailed history: History of present hypertension
❑ Excessive sodium intake >2.4g per day ❑ Eyes:
❑ Cardiovascular:
❑ Kidneys:
| |||||||||||||||||||
Examine the patient: General examination: Neck
Respiratory examination Abdominal examination
| |||||||||||||||||||
Order tests: Routine
❑ EKG Additional tests to diagnose specific etiologies: | |||||||||||||||||||
Does this patient have an identifiable secondary etiology? | |||||||||||||||||||
Yes | No | ||||||||||||||||||
Primary hypertension | Secondary hypertension | ||||||||||||||||||
Proceed to treatment | |||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of