Hypertension Risk Stratification

Aka: Hypertension Risk Stratification, Hypertension Risk Group A, Hypertension Risk Group B, Hypertension Risk Group C, Blood Pressure Goals in Hypertension

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II. Indication

  1. JNC-7 Guide for Hypertension Intervention
  2. JNC-8 Blood Pressures goals (modified as of 2014)
    1. Renal Insufficiency: <140/90 mmHg
    2. Diabetes Mellitus: <140/90 mmHg
      1. ADA recommends <140/80 mmHg
      2. Age >80 years: <150/90 mmHg
    3. No Diabetes Mellitus or renal disease
      1. Age <60 years: <140/90 mmHg
      2. Age >60 years: <150/90 mmHg
    4. References
      1. James (2014) JAMA 311(5):507-20 [PubMed]

III. Precautions

  1. Blood Pressure target remains <140/90 mmHg for most adults with Hypertension (unless otherwise indicated)
    1. Lower Blood Pressure goals (e.g. <130/80) do not reduce mortality and increase adverse effects
    2. Lower Blood Pressure goals may reduce Myocardial Infarctions and Congestive Heart Failure
    3. Arguedas (2020) Cochrane Database Syst Rev 12(12):CD004349 +PMID: 33332584 [PubMed]
  2. Patients with the greatest cardiovascular risk have the greatest benefit from Hypertension control
    1. Sundstrom (2014) Lancet 384(9943): 591-8 [PubMed]

IV. Types: Risk Group A - Low Cardiovascular Risk

  1. Criteria
    1. No Cardiovascular Risks (See Risk Group B)
    2. No Target organ damage or Cardiovascular Disease
  2. Prehypertension (120-139 / 80-89)
    1. Lifestyle Modification in Hypertension
  3. Stage 1 Hypertension (140-159 / 90-99)
    1. Lifestyle Modification in Hypertension
    2. Consider Antihypertensive after up to 6-12 months
      1. Hydrochlorothiazide first choice in most patients
  4. Stage 2 Hypertension or greater (>159/99)
    1. Lifestyle Modification in Hypertension
    2. Hypertension Combination Therapy

V. Types: Risk Group B - Moderate Cardiovascular Risk

  1. Criteria
    1. Tobacco Abuse
    2. Dyslipidemia
    3. Renal Insufficiency
    4. Patient age over 60 years
    5. Male gender of postmenopausal women
    6. Cardiovascular Family History
    7. No Diabetes Mellitus
    8. No Target organ damage or Cardiovascular Disease
  2. Prehypertension (120-139 / 80-89)
    1. Lifestyle Modification in Hypertension
  3. Stage 1 Hypertension (140-159 / 90-99)
    1. Lifestyle Modification in Hypertension
    2. Antihypertensive (e.g. Hydrochlorothiazide)
  4. Stage 2 Hypertension or greater (>159/99)
    1. Lifestyle Modification in Hypertension
    2. Hypertension Combination Therapy

VI. Types: Risk Group C -High Cardiovascular Risk

  1. Criteria
    1. Target organ damage or Cardiovascular Disease
      1. Left Ventricular Hypertrophy
      2. Angina or prior Myocardial Infarction
      3. Prior coronary revascularization
      4. Cerebrovascular Accident (Stroke or CVA)
      5. Transient Ischemic Attack (TIA)
      6. Nephropathy or Chronic Kidney Disease
      7. Peripheral Vascular Disease
      8. Retinopathy
    2. Cardiovascular Risks (See Risk Group B)
  2. Prehypertension (120-139 / 80-89) or greater
    1. Lifestyle Modification in Hypertension
    2. Antihypertensive
    3. Hypertension Combination Therapy if >20/10 over goal

VII. References

  1. (1997) Arch Intern Med 157:2413-46 [PubMed]
  2. Chobanian (2003) JAMA 289:2560-72 [PubMed]

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Related Studies

Ontology: Hypertensive disease (C0020538)

Definition (MEDLINEPLUS)

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure.

Your blood pressure reading uses these two numbers, the systolic and diastolic pressures. Usually they are written one above or before the other. A reading of

  • 119/79 or lower is normal blood pressure
  • 140/90 or higher is high blood pressure
  • Between 120 and 139 for the top number, or between 80 and 89 for the bottom number is prehypertension

High blood pressure usually has no symptoms, but it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. You can control high blood pressure through healthy lifestyle habits and taking medicines, if needed.

NIH: National Heart, Lung, and Blood Institute
Definition (NCI_CDISC) Pathological increase in blood pressure defined as one of the following: History of hypertension diagnosed and treated with medication, diet, and/or exercise; On at least 2 separate occasions, documented blood pressure greater than 140 mm Hg systolic and/or 90 mm Hg diastolic in patients without diabetes or chronic kidney disease, or blood pressure greater than 130 mm Hg systolic or 80 mm Hg diastolic in patients with diabetes or chronic kidney disease; Currently on pharmacological therapy for the treatment of hypertension.
Definition (NCI) Blood pressure that is abnormally high.
Definition (NCI_CTCAE) A disorder characterized by a pathological increase in blood pressure; a repeatedly elevation in the blood pressure exceeding 140 over 90 mm Hg.
Definition (NCI_NCI-GLOSS) A blood pressure of 140/90 or higher. High blood pressure usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness.
Definition (CSP) persistantly high arterial blood pressure.
Definition (MSH) Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more.
Concepts Disease or Syndrome (T047)
MSH D006973
ICD9 997.91, 401-405.99
ICD10 I10-I15.9 , I10, I10-I15
SnomedCT 38341003, 155302005, 194757006, 194760004, 155295004, 194756002, 266287006, 194794002, 195537001
LNC MTHU020789, LA14293-7, LA7444-8
English Hypertension, BLOOD PRESSURE HIGH, HYPERTENSION ARTERIAL, Hypertensive disease NOS, Hypertensive diseases, [X]Hypertensive diseases, Systemic hypertension, Hypertensive disorder, systemic arterial, hyperpiesia, hyperpiesis, systemic HTN, systemic hypertension (diagnosis), systemic hypertension, Hypertension arterial, Blood pressure high, HBP, HT, Hypertension NOS, Surg comp - hypertension, HTN, Hypertension [Disease/Finding], high blood pressure, hypertensive disorder, hypertensive vascular disease, arterial hypertension, arterial hypertension systemic, vascular hypertension, blood high pressure, high blood pressure disorder, systemic arterial hypertension, hypertensive disease, Hypertensive diseases (I10-I15), Complications affecting other specified body systems, not elsewhere classified, hypertension, High Blood Pressure, Hypertensive disease NOS (disorder), Hypertensive disease (disorder), (Hypertensive disease) or (hypertension), (Hypertensive disease) or (hypertension) (disorder), [X]Hypertensive diseases (disorder), hypertension, BLOOD PRESSURE, INCREASED, BLOOD PRESSURE, HIGH, Hypertensive Disorder, HIGH BLOOD PRESSURE, INCREASED BLOOD PRESSURE, HYPERTENSION, PRESSURE, HIGH BLOOD, High blood pressure, Hyperpiesia, Hyperpiesis, Hypertensive vascular degeneration, Hypertensive vascular disease, BP - High blood pressure, High blood pressure disorder, Systemic arterial hypertension, HBP - High blood pressure, BP+ - Hypertension, HT - Hypertension, Hypertensive disorder, systemic arterial (disorder), Hypertensive disorder, HTN - Hypertension, blood pressure; high, high; arterial tension, high; blood pressure, Hypertension, NOS, Hypertensive disease, NOS, Raised blood pressure (disorder), Blood Pressure, High, Blood Pressures, High, High Blood Pressures, Vascular Hypertensive Disorder, Hypertensive disease, HYPERTENSIVE DISEASE
French HYPERTENSION ARTERIELLE, Pression artérielle élevée, PAH, Hypertension SAI, TH, HYPERTENSION, TENSION ARTERIELLE E, Hypertension chronique, Hypertension permanente, Hypertension artérielle, Hypertension
Portuguese HIPERTENSAO, Hipertensão arterial NE, Hipertensão arterial, Pressão arterial alta, HYPERTENSAO ARTERIAL, PRESSAO SANGUINEA ELEVADA, Pressão Arterial Alta, Pressão Sanguínea Alta, Hipertensão
Spanish HIPERTENSION, PRESION SANGUINEA ALTA, Presión sanguínea alta, HTA, Hipertensión NEOM, Hipertensión arterial, HT, HIPERTENSION ARTERIAL, enfermedad hipertensiva, SAI, [X]enfermedades hipertensivas (trastorno), enfermedad hipertensiva, SAI (trastorno), [X]enfermedades hipertensivas, Hypertensive disease NOS, degeneración vascular hipertensiva, enfermedad hipertensiva, enfermedad vascular hipertensiva, hiperpiesia, hiperpiesis, hipertensión arterial (trastorno), hipertensión arterial, presión arterial alta, tensión arterial alta, tensión arterial elevada, Hipertensión, Presión Sanguínea Alta
German HYPERTONIE, Hypertonie, arteriell, Blutdruck, hoch, HBP, HT, Hypertonie NNB, BLUTDRUCK HOCH, HYPERTONIE ARTERIELL, Hypertension, Hypertonie
Dutch hypertensie NAO, hoge bloeddruk, arteriële hypertensie, bloeddruk; hoog, hoog; arteriële druk, hoog; bloeddruk, hypertensie, Bloeddruk, hoge, Hypertensie
Italian Ipertensione (HT), Ipertensione NAS, Pressione del sangue elevata, Ipertensione, Pressione sanguigna alta, Ipertensione arteriosa
Japanese 動脈性高血圧, 高血圧ＮＯＳ, ｺｳｹﾂｱﾂ, ｺｳｹﾂｱﾂNOS, ﾄﾞｳﾐｬｸｾｲｺｳｹﾂｱﾂ, 高血圧, 高血圧症
Swedish Högt blodtryck
Czech hypertenze, Arteriální hypertenze, Vysoký krevní tlak, Hypertenze NOS, Hypertenze, vysoký krevní tlak, hypertonie
Finnish Kohonnut verenpaine
Russian GIPERTENZIIA, GIPERTONICHESKAIA BOLEZN', KROVIANOE DAVLENIE VYSOKOE, ГИПЕРТЕНЗИЯ, ГИПЕРТОНИЧЕСКАЯ БОЛЕЗНЬ, КРОВЯНОЕ ДАВЛЕНИЕ ВЫСОКОЕ
Croatian HIPERTENZIJA
Polish Nadciśnienie
Hungarian Arteriás hypertonia, Hypertensio, HT, RR magas, Hypertonia k.m.n., Magas vérnyomás
Norwegian Høyt blodtrykk, Hypertensjon, Hypertoni
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Hypertension

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