Hypertension

Hypertension is a major risk factor for coronary artery disease (CAD), heart failure, stroke, and renal failure. Approximately 50 million Americans have hypertension. I. Clinical evaluation of the hypertensive patient

A. Evaluation of hypertension should include an assessment of missed doses of maintenance antihypertensive therapy, use of nonsteroidal antiinflammatory drugs, decongestants, diet medications, cocaine, or amphetamines.

B. History should exclude the presence of coronary heart disease (chest pain), hyperlipidemia, diabetes, smoking, or prostatic hypertrophy. These disorders may influence the choice of antihypertensive.

C. Physical examination. The diagnosis of hypertension requires three separate readings of at least 140/90. The physical exam should search for retinal hemorrhages, carotid bruits, left ventricular enlargement, coarctation of the aorta, aortic aneurysm, and absence of a peripheral pulse in an extremity.

Classification of Blood Pressure (mmHg) in the JNC VI

Category

Systolic

Diastolic

Follow-up recommendation

Optimal

<120

and

<80

Normal

<130

and

<85

Recheck in 2 y

High-normal

130-139

or

85-89

Recheck in 1 y

Hypertension

Stage 1

140-159

or

90-99

Confirm within 2 mo

Stage 2

160-179

or

100-109

Evaluate within 1 mo

Stage 3

>180

or

>110

Evaluate immediately or within weeks

Isolated systolic hypertension

>140

and

<90

Depends on stage

Your Heart and Nutrition

Your Heart and Nutrition

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