II. Indication
- JNC-7 Guide for Hypertension Intervention
- JNC-8 Blood Pressures goals (modified as of 2014)
- Renal Insufficiency: <140/90 mmHg
- Diabetes Mellitus: <140/90 mmHg
- ADA recommends <140/80 mmHg
- Age >80 years: <150/90 mmHg
- No Diabetes Mellitus or renal disease
- Age <60 years: <140/90 mmHg
- Age >60 years: <150/90 mmHg
- References
III. Precautions
-
Blood Pressure target remains <140/90 mmHg for most adults with Hypertension (unless otherwise indicated)
- Lower Blood Pressure goals (e.g. <130/80) do not reduce mortality and increase adverse effects
- Lower Blood Pressure goals may reduce Myocardial Infarctions and Congestive Heart Failure
- Arguedas (2020) Cochrane Database Syst Rev 12(12):CD004349 +PMID: 33332584 [PubMed]
- Patients with the greatest cardiovascular risk have the greatest benefit from Hypertension control
IV. Types: Risk Group A - Low Cardiovascular Risk
- Criteria
- No Cardiovascular Risks (See Risk Group B)
- No Target organ damage or Cardiovascular Disease
- Prehypertension (120-139 / 80-89)
-
Stage 1 Hypertension (140-159 / 90-99)
- Lifestyle Modification in Hypertension
- Consider Antihypertensive after up to 6-12 months
- Hydrochlorothiazide first choice in most patients
- Stage 2 Hypertension or greater (>159/99)
V. Types: Risk Group B - Moderate Cardiovascular Risk
- Criteria
- Tobacco Abuse
- Dyslipidemia
- Renal Insufficiency
- Patient age over 60 years
- Male gender of postmenopausal women
- Cardiovascular Family History
- No Diabetes Mellitus
- No Target organ damage or Cardiovascular Disease
- Prehypertension (120-139 / 80-89)
-
Stage 1 Hypertension (140-159 / 90-99)
- Lifestyle Modification in Hypertension
- Antihypertensive (e.g. Hydrochlorothiazide)
- Stage 2 Hypertension or greater (>159/99)
VI. Types: Risk Group C -High Cardiovascular Risk
- Criteria
- Target organ damage or Cardiovascular Disease
- Left Ventricular Hypertrophy
- Angina or prior Myocardial Infarction
- Prior coronary revascularization
- Cerebrovascular Accident (Stroke or CVA)
- Transient Ischemic Attack (TIA)
- Nephropathy or Chronic Kidney Disease
- Peripheral Vascular Disease
- Retinopathy
- Cardiovascular Risks (See Risk Group B)
- Target organ damage or Cardiovascular Disease
- Prehypertension (120-139 / 80-89) or greater
- Lifestyle Modification in Hypertension
- Antihypertensive
- Hypertension Combination Therapy if >20/10 over goal