Abstract
Hypertension has been defined as blood pressure levels of 140/90mm Hg or greater. This has been arbitrarily based on epidemiological evidence that demonstrates the risk associated with blood pressure levels and the benefits to be expected from therapy. Conventional blood pressure measurements with a sphygmomanometer are adequate in most patients for evaluation of arterial hypertension. Out-of-office self-measurements of blood pressure or 24-hour blood pressure recordings provide useful additional information and can help to exclude ‘white coat hypertension’ or office hypertension.
The objective of screening patients with hypertension is to detect any treatable causes and to assess the cardiovascular risk by ascertaining the extent of target organ damage and other cardiovascular risk factors. Abasic screening programme is appropriate in the majority of older patients with hypertension to exclude treatable causes. Additional investigations are necessary in young patients and those with suspicion of an identifiable cause.
Target organ damage and cardiovascular risk factors have to be evaluated in each patient with hypertension since the incidence of cardiovascular disease is related to the profile of these risk factors. Accordingly, the clinical management of patients with hypertension depends not on blood pressure levels alone but also on the burden of associated risk factors. The Sixth Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure has recently recommended a classification that stratifies patients with hypertension into risk groups for therapeutic decisions. It has to be pointed out that there is uncertainty about the prognostic relevance of risk stratification in patients over the age of 80 years.
Similar content being viewed by others
References
MacMahon S, Cutler JA, Stamler J. Antihypertensive drug treatment. Potential, expected, and observed effects on stroke and coronary heart disease. Hypertension 1989; 13 Suppl. I: I45–50
Hypertension Detection and Follow-Up Program Cooperative Group. Five-Year Findings of the Hypertension Detection and Follow-Up Program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA 1979; 242: 2572–7
The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997; 157: 2413-55
The Pooling Project Research Group. Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: Final report of the pooling project. J Chronic Dis 1978; 31: 201–7
Zanchetti A, Mancia G. The centenary of blood pressure measurement: a tribute to Scipione Riva Rocci. J Hypertens 1996; 14: 1–12
King GE. Selection of blood pressure cuff design. Lancet 1982; II: 492–3
Montfrans GH, van der Hoeven GMA, Karemaker JM, et al. Accuracy of auscultatory blood pressure measurement with a long cuff. BMJ 1987; 295: 354–5
Frohlich ED, Grim C, Labarthe DR, et al. Recommendations for human blood pressure determination by sphygmomanometers. Hypertension 1988; 10: 210A–22A
Alderman MH, Yano K. How the prevalence of hypertensives varies as diagnostic criteria change. Am J Med Sci 1976; 27: 343–9
Ohkubo T, Imai Y, Tsuji I, et al. Home blood pressure measurement has a stronger predictive power for mortality than dose screening blood pressure measurement: a population-based observation in Ohasama, Japan. J Hypertens 1998; 16: 971–5
Mancia G, Di Rienzo M, Parati G. Ambulatory blood pressure monitoring use in hypertension research and clinical practice. Hypertension 1993; 21: 510–24
Guidelines Subcommittee: 1999 Word Health Organization. International society of hypertension guidelines for the management of hypertension. J Hypertens 1999; 17: 151–83
Pickering TG. The clinical significance of diurnal pressure variations: dippers and non-dippers. Circulation 1990; 81: 700–2
Mancia G, Bertinieri G, Grassi G, et al. Effects of blood pressure measurements by the doctor on patients’s blood pressure and heart rate. Lancet 1983; II: 695–8
Saito I, Takeshita E, Hayashi, et al. Comparison of clinical and home blood pressure levels and the role of the sympathetic nervous system in clinical-home differences. Am J Hypertens 1990; 1990; 3: 219–24
Prisant LM, Carr AA. Ambulatory blood pressure monitoring an echo-cardiographic left ventricular wall thickness and mass. Am J Hypertens 1990; 3: 81
Appel LJ, Stason WB. Ambulatory blood pressure monitoring and blood pressure self-measurement in the diagnosis and management of hypertension. Ann Intern Med 1993; 118: 867–82
Pickering T, for the American Society of Hypertension. Recommendations for the use of home (self) and ambulatory blood pressure monitoring. Am J Hypertens 1995; 9: 1–11
Pickering TG, James GD, Boddie C, et al. How common is white coat hypertension. JAMA 1988; 259: 225–8
Baumgart P, Walger P, Jürgens U, et al. Reference data for ambulatory blood pressure monitoring: what results are equivalent to the established limits of office blood pressure? Klin Wochenschr 1990; 68: 723–7
Zweifler AJ, Shahab ST. Pseudohypertension: a new assessment. J Hypertens 1993; 11: 1–6
Lever AF, Swales JD. Investigating the hypertensive patient: an overview. In: Swales JD, editor. Textbook of hypertension. Oxford: Blackwell, 1994: 1026–30
Davidson RA, Wilcox CS. Diagnostic usefulness of renal scanning after angiotensin converting enzyme inhibitors. Hypertension 1991; 18: 299–303
National High Blood Pressure Education Program Working Group. 1995 Update of the working group reports on chronic renal failure and renovascular hypertension. Arch Intern Med 1996; 156: 1938–47
Keith NM, Wagner HP, Barker NW. Some different types of essential hypertension: their cause and prognoses. Am J Sci 1939; 197: 332–43
Dimmitt SB, West JNW, Eames SM, et al. Usefulness of ophthalmoscopy in mild to moderate hypertension. Lancet 1989; I: 1103–6
Mejia AD, Egan BM, Schork MJ, et al. Artefacts in measurement of blood pressure and lack of target organ involvement in the assessment of patients with treatment-resistant hypertension. Ann Intern Med 1990; 11: 270–7
Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographic determined left ventricular mass in the Framingham heart study. N Engl J Med 1991; 322: 1561–6
Simone G, Ganau A, Verdecchia P, et al. Echocardiography in arterial hypertension: when, why, and how? J Hypertens 1994; 12: 1129–36
Dunn FG, Pringle SD. Echocardiography in arterial hypertension: when, why and how? J Hypertens 1994; 12: 1137–8
Wolf PA, Kannel WB, McGee DL. Prevention of ischemic stroke: risk factors. In: Barnett HJM, Stein BM, Mohr JP, et al., editors. Stroke. New York: Churchill Livingstone, 1986: 967–88
Laragh JH, Blumenfeld JD. Essential hypertension. In: Brenner BM, editor. Brenner and Rectors’s the kidney. 5th ed. Vol. II. Philadelphia: W.B. Saunders, 1996: 2071–105
Krumholz HM, Seemann TE, Merril SS, et al. Lack of association between cholesterol and coronary heart disease mortality in persons older than 70 years. JAMA 1994; 272: 1335–40
Reaven GM, Lthell H, Landsberg L. Mechanisms of disease: hypertension and associated metabolic abnormalities — the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996; 334: 374–81
Anderson KM, Wilson PWF, Odell PM, et al. An updated coronary risk profile. A statement for health professionals. Circulation 1991; 83: 356–62
WHO expert committee on hypertension control. Hypertension control. Report of a WHO expert committee. Geneva: World Health Organization 1996. WHO Technical Report Series No. 862
MacMahon S, Rodgers A. The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives. J Clin Exp Hypertens 1993; 15: 967–78
World Health Organization — International Society of Hypertension Blood Pressure Lowering Treatment Trialistss’ Collaboration. Protocol for prospective collaborative overviews of major randomized trials of blood pressure lowering treatments. J Hypertens 1998; 16: 127–37
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Barenbrock, M., Hausberg, M. & Spieker, C. Evaluation of Patients with Hypertension. Dis-Manage-Health-Outcomes 5, 263–271 (1999). https://doi.org/10.2165/00115677-199905050-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00115677-199905050-00003