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Hypertension Risk Stratification

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

  • 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]
  • Precautions
  1. Patients with the greatest cardiovascular risk have the greatest benefit from Hypertension control
    1. Sundstrom (2014) Lancet 384(9943): 591-8 [PubMed]
  • 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
  • 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
  • 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