HIGH BLOOD PRESSURE
(hypertension)
DECTCTION & CONFIRMATION Detection and Confirmation Hypertension detection begins with proper blood pressure measurements, which should be obtained at each health care encounter. Repeated blood pressure measurements will determine whether initial elevations persist and require prompt attention or have returned to normal and need only periodic surveillance. Blood pressure should be measured in a standardized fashion using equipment that meets cerified criteria. SEF MESSURING OF BP Measurement of blood pressure outside the clinician's office may provide valuable information for the initial evaluation of patients with hypertension and for monitoring the response to treatment. Self-measurement has 4 general advantages: (1) distinguishing sustained hypertension from "white-coat hypertension," a condition noted in patients whose blood pressure is consistently elevated in the physician's office or clinic but normal at other times; (2) assessing response to antihypertensive medication; (3) improving patient adherence to treatment; and ( 4) potentially reducing costs.The blood pressure of persons with hypertension tends to be higher when measured in the clinic than outside the office. There is no universally agreed-on upper limit of normal home blood pressure, but readings of 135/85 mm Hg or greater should be considered elevated. EVALUATION PREVENTION & TREATMENT OF HIGH BLOOD PRESSURE PREVENTION AND TREATMENT OF HIGH BLOOD PRESSURE Before considering the active treatment of established hypertension, the even greater need for prevention of disease should be recognized. Without primary prevention, the hypertension problem would never be solved and would rely Solely on detection of existing high blood pressure. Primary prevention provides an attractive opportunity to interrupt and prevent the continuing costly cycle of managing hypertension and its complications. Primary revention reflects a number of realities: A significant portion of cardiovascular disease occurs in people whose blood pressure is above the optima l level (120/80 mm Hg) but not so high as to be diagnosed or treated as hypertension. A population-wide approach to lowering blood pressure can reduce this considerable burden of risk. Active treatment of established hypertension, as carefully as can be provided, poses financial costs and potential adverse effects. Most patients with established hypertension do not make sufficient lifestyle changes, do not take medication, or do not take enough medication to achieve control. Even if adequately treated according to current standards, patients with hypertension may not lower their risk to that of persons with normal blood pressure. Blood pressure rise and high blood pressure are not inevitable consequences of aging. Evaluation of patients with documented hypertension has 3 objectives: (1) to identify known causes of high blood pressure; (2) to assess the presence or absence of target organ damage and cardiovascular disease, the extent of the disease, and the response to therapy; and (3) to identify other cardiovascular risk factors or concomitant disorders that may define prognosis and guide treatment. Data for evaluation are acquired through medical history, physical examination, laboratory tests, and other testing LINKS on BLOOD PRESSURE