Summary
Definition
History and exam
Key diagnostic factors
- systolic blood pressure (BP) ≥130 mmHg or diastolic BP ≥80 mmHg
- retinopathy
Other diagnostic factors
- headache
- visual changes
- dyspnea
- chest pain
- sensory or motor deficit
Risk factors
- obesity
- aerobic exercise <3 times/week
- moderate/high alcohol intake
- metabolic syndrome or cardiovascular-kidney-metabolic (CKM) syndrome
- diabetes mellitus
- black ancestry
- age >60 years
- family history of hypertension or chronic coronary disease
- sleep apnea
- sodium intake >1.5 g/day
- low fruit and vegetable intake
- dyslipidemia
- smoking
Diagnostic investigations
1st investigations to order
- urinary albumin-to-creatinine ratio (UACR)
- ECG
- fasting metabolic panel with estimated GFR
- lipid panel
- urinalysis
- hemoglobin
- thyroid-stimulating hormone
Investigations to consider
- plasma renin activity
- plasma aldosterone
- renal duplex ultrasound/MRA renal arteries/CT angiography
- 24-hour urine pheochromocytoma screen
- plasma fractionated metanephrines
- 24-hour urine free cortisol
- sleep study
- echocardiography
Treatment algorithm
without chronic renal disease or cardiovascular disease (CVD)-related comorbidity: stage 1 hypertension and lower CVD risk and without diabetes
without chronic renal disease or cardiovascular disease (CVD)-related comorbidity: higher CVD risk or with diabetes
concomitant chronic coronary disease without congestive heart failure
concomitant heart failure (HF)
concomitant left ventricular hypertrophy without chronic coronary disease
concomitant chronic renal disease without cardiovascular disease
concomitant atrial fibrillation without other comorbidity
refractory/resistant to optimized triple therapy at any stage
Contributors
Authors
Jeffrey Brettler, MD, FASH
Internal Medicine
Regional Hypertension Co-lead, Kaiser Permanente Southern California, Los Angeles
Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
CA
Disclosures
JB declares that he has no competing interests.
Acknowledgements
Dr Jeffrey Brettler would like to gratefully acknowledge Dr Joel Handler, Dr Jonathan N. Bella, Dr Moustapha Atoui, Dr Liran Blum, and Dr Michael A. Spinelli, previous contributors to this topic.
Disclosures
JH, JNB, MA, LB, and MAS declare that they have no competing interests.
Peer reviewers
Isla Mackenzie, MBChB, PhD, FRCP
Clinical Senior Lecturer in Clinical Pharmacology and Honorary Consultant Physician
University of Dundee
Dundee
UK
利益声明
IM is an elected member of the British Hypertension Society Executive Committee.
Syed Wamique Yusuf, MRCPI, FACC
Associate Professor
Department of Cardiology
University of Texas MD Anderson Cancer Center
Houston
TX
利益声明
SWY declares that he has no competing interests.
Melvin Lobo, MBChB, PhD, MRCP
Director Barts Blood Pressure Centre of Excellence
NHS Reader in Cardiovascular Medicine
Department of Clinical Pharmacology
William Harvey Heart Centre
London
UK
利益声明
ML is a consultant for ROX Medical. ML receives honorarium from Cardiosonic, St. Jude Medical, and institutional grant/research support from Medtronic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
McEvoy JW, McCarthy CP, Bruno RM, et al. 2024 ESC guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024 Oct 7;45(38):3912-4018.全文
Whelton PK, Carey RM, Aronow WS, et al. 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: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248.全文 摘要
Rabi DM, McBrien KA, Sapir-Pichhadze R, et al. Hypertension Canada's 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children. Can J Cardiol. 2020 May;36(5):596-624.全文 摘要
Wright JT Jr, Williamson JD, Whelton PK, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood pressure control. N Engl J Med. 2015 Nov 26;373(22):2103-16.全文 摘要
Williams B, MacDonald TM, Morant S, et al; British Hypertension Society's PATHWAY Studies Group. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet. 2015 Nov 21;386(10008):2059-68.全文 摘要
Rosendorff C, Lackland DT, Allison M, et al. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Hypertension. 2015 Jun;65(6):1372-407.全文 摘要
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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