Chronic hypertension screening: Difference between revisions

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__NOTOC__
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{{Hypertension}}
{{Chronic hypertension}}
{{CMG}}: {{AE}} {{AN}}
{{CMG}}: {{AE}} [[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]]
==Overview==
==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<ref name="pmid12748199">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12748199}}</ref>. 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).<ref name="pmid20065196">{{cite journal| author=Ferket BS, Colkesen EB, Visser JJ, Spronk S, Kraaijenhagen RA, Steyerberg EW et al.| title=Systematic review of guidelines on cardiovascular risk assessment: Which recommendations should clinicians follow for a cardiovascular health check? | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 1 | pages= 27-40 | pmid=20065196 | doi=10.1001/archinternmed.2009.434 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20065196  }} </ref>
The age to begin screening for hypertension varies between 13-20 years of age, according to different authorities. Generally, hypertension is defined as SBP > 140 mmHg and/or DBP > 90 mmHg. In specific populations, however, routine follow-up target BP may be different; and initiation of treatment may be considered at even lower BP values than those considered for the normal population.


==Screening==
==Screening==
U.S. Preventive Services Task Force (USPSTF) <ref name="pmid20065196">{{cite journal| author=Ferket BS, Colkesen EB, Visser JJ, Spronk S, Kraaijenhagen RA, Steyerberg EW et al.| title=Systematic review of guidelines on cardiovascular risk assessment: Which recommendations should clinicians follow for a cardiovascular health check? | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 1 | pages= 27-40 | pmid=20065196 | doi=10.1001/archinternmed.2009.434 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20065196  }} </ref> and JNC 7 <ref name="pmid16512265">{{cite journal| author=Cuddy ML| title=Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1). | journal=J Pract Nurs | year= 2005 | volume= 55 | issue= 4 | pages= 17-21; quiz 22-3 | pmid=16512265 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16512265  }} </ref> recommendations for hypertension screening:
*Screening is recommended every 2 years if the blood pressure < 120/80 mmHg
*Screening is recommended yearly if initial blood pressure screening revealed JNC 7’s pre-hypertension stage: the systolic blood pressure is between 120 139 mmHg and/or the diastolic blood pressure is between 80 and 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 blood pressure > 180/110 mmHg. Clinical situation and complications are to be taken into major consideration.
*Treatment may be initiated immediately at lower blood pressure values in specific populations, such as those known to have Diabetes Mellitus.


===Screening Test<ref name="pmid12748199">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12748199}}</ref>===
The age to start screening for hypertension varies according to different authorities:
{|border="1" style="border-collapse:collapse; text-align:left; font-size:120%;" cellpadding="5" align="center" width="900px"
| bgcolor="#67e1ff" align="center"|'''Authority'''||bgcolor="#67e1ff" align="center"|'''Age to Start Screening for Hypertension'''
|-
|bgcolor="#f3f3f3"|The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)<ref name="pmid14656957">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14656957  }} </ref>
| 20 years
|-
| bgcolor="#f3f3f3"|American Heart Association (AHA)<ref name="pmid12119259">{{cite journal| author=Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP et al.| title=AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee. | journal=Circulation | year= 2002 | volume= 106 | issue= 3 | pages= 388-91 | pmid=12119259 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12119259 }} </ref>
| 20 years
|-
| bgcolor="#f3f3f3"|American Academy of Family Physicians (AAFP)<ref name="pmid18056662">{{cite journal| author=U.S. Preventive Services Task Force| title=Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. | journal=Ann Intern Med | year= 2007 | volume= 147 | issue= 11 | pages= 783-6 | pmid=18056662 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18056662 }} </ref>
| 18 years
|-
| bgcolor="#f3f3f3"|American College of Obstetricians and Gynecologists (ACOG)<ref name="pmid17138804">{{cite journal| author=ACOG Committee on Gynecologic Practice| title=ACOG Committee Opinion No. 357: Primary and preventive care: periodic assessments. | journal=Obstet Gynecol | year= 2006 |volume= 108 | issue= 6 | pages= 1615-22 | pmid=17138804 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17138804 }} </ref>
| 13 years
|}
 
==The U.S. Preventive Services Task Force (USPSTF)<ref name="pmid20065196">{{cite journal| author=Ferket BS, Colkesen EB, Visser JJ, Spronk S, Kraaijenhagen RA, Steyerberg EW et al.| title=Systematic review of guidelines on cardiovascular risk assessment: Which recommendations should clinicians follow for a cardiovascular health check? | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 1 | pages= 27-40 | pmid=20065196 | doi=10.1001/archinternmed.2009.434 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20065196 }} </ref> and JNC 7<ref name="pmid14656957">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.|title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. |journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14656957 }} </ref> Screening Recommendations==
 
*'''If SBP < 120 mmHg and DBP < 80 mmHg''': Screening is recommended every 2 years
*'''If SBP = 120-139 mmHg and/or DBP = 80-89 mmHg''': Screening is recommended yearly
*'''If SBP = 140-159 mmHg and/or DBP = 90-99 mmHg''': Confirmation of BP values within 2 months is required
*'''If SBP = 160-180 mmHg and/or DBP > 110 mmHg''': Evaluation or referral to source of care within 1 month
*'''If SBP > 180 mmHg''': Evaluation and treatment immediately or within 1 week. Clinical situation and complications are to be taken into major consideration.


{|style="width:80%; height:100px" border="1" align="center"
==2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults==
|style="height:100px"; style="width:50%" border="1" bgcolor="LightSteelBlue" | '''Diagnosis'''
 
|style="height:100px"; style="width:50%" border="1" bgcolor="LightSteelBlue" | '''Diagnostic Tests'''
===Secondary Forms of Hyperpertension===
 
{| class="wikitable" style="width:80%"
|-
|-
|-bgcolor="Beige"
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| [[Chronic kidney disease]]
|bgcolor="Beige"| Estimate [[GFR]]
|-
|-
|-bgcolor="Beige"
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Screening for specific form(s) of secondary hypertension is recommended when the clinical indications and physical examination findings are present or in adults with resistant hypertension.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])'' <nowiki>"</nowiki>
| [[Coarctation of aorta]]
|bgcolor="Beige"| [[CT angiography]]
|-
|-
|-bgcolor="Beige"
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| [[Cushing's syndrome]] and other [[glucocorticoid]] excess states including chronic steroid therapy
|bgcolor="Beige"| History; [[dexamethasone suppression test]]
|-
|-
|-bgcolor="Beige"
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' If an adult with sustained hypertension screens positive for a form of secondary hypertension, referral to a physician with expertise in that form of hypertension may be reasonable for diagnostic confirmation and treatment. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])'' <nowiki>"</nowiki>
| Drug induced/related
|}
|bgcolor="Beige"| History; drug screening
 
====Primary Aldosteronism====
 
{| class="wikitable" style="width:80%"
|-
|-
|-bgcolor="Beige"
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| [[Pheochromocytoma]]
|bgcolor="Beige"| 24 hour urinary metanephrine and normetanephrine
|-
|-
|-bgcolor="Beige"
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' In adults with hypertension, screening for primary aldosteronism is recommended in the presence of any of the following concurrent conditions: resistant hypertension, hypokalemia (spontaneous or substantial, if diuretic induced), incidentally discovered adrenal mass, family history of early-onset hypertension, or stroke at a young age (<40 years).''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])'' <nowiki>"</nowiki>
| Primary [[aldosteronism]] and other [[mineralocorticoid]] 24-hour urinary [[aldosterone]] level or excess states
|bgcolor="Beige"| 24-hour urinary [[aldosterone]] level or specific measurements of other mineralocorticoids
|-
|-
|-bgcolor="Beige"
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' Use of the plasma aldosterone: renin activity ratio is recommended when adults are screened for primary aldosteronism.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
| [[Renovascular hypertension]]
|-
|bgcolor="Beige"| [[Doppler]] flow study; [[magnetic resonance angiography]]
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''3.''' In adults with hypertension and a positive screening test for primary aldosteronism, referral to a hypertension specialist or endocrinologist is recommended for further evaluation and treatment.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])'' <nowiki>"</nowiki>
|}
 
====Renal Artery Stenosis====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Medical therapy is recommended for adults with atherosclerotic renal artery stenosis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' In adults with renal artery stenosis for whom medical management has failed (refractory hypertension, worsening renal function, and/or intractable HF) and those with nonatherosclerotic disease, including fibromuscular dysplasia, it may be reasonable to refer the patient for consideration of revascularization (percutaneous renal artery angioplasty and/or stent placement). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])'' <nowiki>"</nowiki>
|}
 
====Obstructive Sleep Apnea====
 
{| class="wikitable" style="width:80%"
|-
|-
|-bgcolor="Beige"
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| [[Sleep apnea]]
|bgcolor="Beige"| Sleep study with O2 saturation
|-
|-
|-bgcolor="Beige"
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' In adults with hypertension and obstructive sleep apnea, the effectiveness of continuous positive airway pressure (CPAP) to reduce BP is not well established. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
| [[Thyroid]]/ [[Parathyroid]] disease
|bgcolor="Beige"| [[TSH]]; serum [[PTH]]
|}
|}


Latest revision as of 21:30, 24 November 2017

Chronic Hypertension Microchapters

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Overview

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Differentiating Hypertension from other Diseases

Epidemiology and Demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Yazan Daaboul, Serge Korjian

Overview

The age to begin screening for hypertension varies between 13-20 years of age, according to different authorities. Generally, hypertension is defined as SBP > 140 mmHg and/or DBP > 90 mmHg. In specific populations, however, routine follow-up target BP may be different; and initiation of treatment may be considered at even lower BP values than those considered for the normal population.

Screening

The age to start screening for hypertension varies according to different authorities:

Authority Age to Start Screening for Hypertension
The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)[1] 20 years
American Heart Association (AHA)[2] 20 years
American Academy of Family Physicians (AAFP)[3] 18 years
American College of Obstetricians and Gynecologists (ACOG)[4] 13 years

The U.S. Preventive Services Task Force (USPSTF)[5] and JNC 7[1] Screening Recommendations

  • If SBP < 120 mmHg and DBP < 80 mmHg: Screening is recommended every 2 years
  • If SBP = 120-139 mmHg and/or DBP = 80-89 mmHg: Screening is recommended yearly
  • If SBP = 140-159 mmHg and/or DBP = 90-99 mmHg: Confirmation of BP values within 2 months is required
  • If SBP = 160-180 mmHg and/or DBP > 110 mmHg: Evaluation or referral to source of care within 1 month
  • If SBP > 180 mmHg: Evaluation and treatment immediately or within 1 week. Clinical situation and complications are to be taken into major consideration.

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

Secondary Forms of Hyperpertension

Class I
"1. Screening for specific form(s) of secondary hypertension is recommended when the clinical indications and physical examination findings are present or in adults with resistant hypertension.(Level of Evidence: C-EO) "
Class IIb
"1. If an adult with sustained hypertension screens positive for a form of secondary hypertension, referral to a physician with expertise in that form of hypertension may be reasonable for diagnostic confirmation and treatment. (Level of Evidence: C-EO) "

Primary Aldosteronism

Class I
"1. In adults with hypertension, screening for primary aldosteronism is recommended in the presence of any of the following concurrent conditions: resistant hypertension, hypokalemia (spontaneous or substantial, if diuretic induced), incidentally discovered adrenal mass, family history of early-onset hypertension, or stroke at a young age (<40 years).(Level of Evidence: C-EO) "
"2. Use of the plasma aldosterone: renin activity ratio is recommended when adults are screened for primary aldosteronism.(Level of Evidence: C-LD) "
"3. In adults with hypertension and a positive screening test for primary aldosteronism, referral to a hypertension specialist or endocrinologist is recommended for further evaluation and treatment.(Level of Evidence: C-EO) "

Renal Artery Stenosis

Class I
"1. Medical therapy is recommended for adults with atherosclerotic renal artery stenosis.(Level of Evidence: A) "
Class IIb
"1. In adults with renal artery stenosis for whom medical management has failed (refractory hypertension, worsening renal function, and/or intractable HF) and those with nonatherosclerotic disease, including fibromuscular dysplasia, it may be reasonable to refer the patient for consideration of revascularization (percutaneous renal artery angioplasty and/or stent placement). (Level of Evidence: C-EO) "

Obstructive Sleep Apnea

Class IIb
"1. In adults with hypertension and obstructive sleep apnea, the effectiveness of continuous positive airway pressure (CPAP) to reduce BP is not well established. (Level of Evidence: B-R) "

References

  1. ↑ 1.0 1.1 Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL; et al. (2003). "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure". Hypertension. 42 (6): 1206–52. doi:10.1161/01.HYP.0000107251.49515.c2. PMID 14656957.
  2. ↑ Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP; et al. (2002). "AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee". Circulation. 106 (3): 388–91. PMID 12119259.
  3. ↑ U.S. Preventive Services Task Force (2007). "Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement". Ann Intern Med. 147 (11): 783–6. PMID 18056662.
  4. ↑ ACOG Committee on Gynecologic Practice (2006). "ACOG Committee Opinion No. 357: Primary and preventive care: periodic assessments". Obstet Gynecol. 108 (6): 1615–22. PMID 17138804.
  5. ↑ 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.

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