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Blood Pressure: Definition, Diagnosis, and Management

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Book cover Hypertension and Stroke

Part of the book series: Clinical Hypertension and Vascular Diseases ((CHVD))

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Abstract

Defining hypertension involves choosing a place in the relationship between increasing levels of blood pressure on the one hand, and the occurrence of outcomes like stroke, heart disease, and death on the other hand. The choice of this “cutpoint” between normotension and hypertension is made further challenging because one needs to take into account the benefits of antihypertensive therapies, as well as their risks. In this chapter we will define hypertension based on evidence that there exists for most target organs a point where the risks of treating blood pressure are outweighed by the benefits of reducing it. This cutpoint could well be different for the brain, the heart, and the kidney, the most commonly involved target organs of hypertension. However, in general the preponderance of evidence suggests that a systolic blood pressure value of 140 mmHg and a diastolic blood pressure value of 90 mmHg represent reasonable approximations of where the evidence indicates the current cutpoints should reside.

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References

  1. Muldoon MF, Rutan GH. Defining hypertension: never as simple as it seems. J Hypertens. 2003;21(3):473–4.

    Article  CAS  PubMed  Google Scholar 

  2. Fisher JW. The diagnostic value of the sphygmomanometer in examinations for life insurance. JAMA. 1914;63:1752–4.

    Article  Google Scholar 

  3. Perera GA. Hypertensive vascular disease; description and natural history. J Chronic Dis. 1955;1:33–42.

    Article  CAS  PubMed  Google Scholar 

  4. Goldring W, Chasis H. Antihypertensive drug therapy: an appraisal. In: Ingelfinger FJ, Relman AS, editors. Controversies in international medicine. Philadelphia: Saunders; 1966. p. 83.

    Google Scholar 

  5. Keith NM, Wagener HP, Barker NW. Some different types of essential hypertension: their course and prognosis. Am J Med Sci. 1939;197:332–43.

    Article  Google Scholar 

  6. Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA 1967; 202(11):1028–34.

    Google Scholar 

  7. Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA 1970;213(7):1143–152.

    Google Scholar 

  8. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, Lefevre ML, Mackenzie TD, Ogedegbe O, Smith Jr SC, Svetkey LP, Taler SJ, Townsend RR, Wright Jr JT, Narva AS, Ortiz E. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.

    Article  CAS  PubMed  Google Scholar 

  9. Chirinos JA, Segers P, Duprez DA, Brumback L, Bluemke DA, Zamani P, Kronmal R, Vaidya D, Ouyang P, Townsend RR, Jacobs DR. Late systolic central hypertension as a predictor of incident heart failure: the multi-ethnic study of atherosclerosis. J Am Heart Assoc. 2015;4(3), e001335.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O’Connor CM, O’Gara PT, Ogedegbe O, Oparil S, White WB. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Circulation. 2015;131(19):e435–e470.

    Google Scholar 

  11. Wright Jr JT, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med. 2014;160(7):499–503.

    Article  PubMed  Google Scholar 

  12. Flack JM, Sica DA, Bakris G, Brown AL, Ferdinand KC, Grimm Jr RH, Hall WD, Jones WE, Kountz DS, Lea JP, Nasser S, Nesbitt SD, Saunders E, Scisney-Matlock M, Jamerson KA. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. 2010;56(5):780–800.

    Article  CAS  PubMed  Google Scholar 

  13. Hartley RM, Velez R, Morris RW, D’Souza MF, Heller RF. Confirming the diagnosis of mild hypertension. Br Med J (Clin Res Ed). 1983;286(6361):287–9.

    Article  CAS  Google Scholar 

  14. http://www.nice.org.uk/guidance/cg127. http://www.nice.org.uk/guidance/cg127. 2014.

  15. Cloutier L, Daskalopoulou SS, Padwal RS, Lamarre-Cliche M, Bolli P, McLean D, Milot A, Tobe SW, Tremblay G, McKay DW, Townsend R, Campbell N, Gelfer M. A new algorithm for the diagnosis of hypertension in Canada. Can J Cardiol. 2015;31:620–30.

    Article  PubMed  Google Scholar 

  16. Mosenkis A, Townsend RR. Sitting on the evidence: what is the proper patient position for the office measurement of blood pressure? J Clin Hypertens (Greenwich). 2005;7(6):365–6.

    Article  Google Scholar 

  17. Clark CE, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012;379(9819):905–14.

    Article  PubMed  Google Scholar 

  18. Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, Ferdinand KC, Ann FM, Frishman WH, Jaigobin C, Kostis JB, Mancia G, Oparil S, Ortiz E, Reisin E, Rich MW, Schocken DD, Weber MA, Wesley DJ. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Coll Cardiol. 2011;57(20):2037–114.

    Google Scholar 

  19. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111(5):697–716.

    Article  PubMed  Google Scholar 

  20. Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. Call to action on use and reimbursement for home blood pressure monitoring: executive summary: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52(1):1–9.

    Article  CAS  PubMed  Google Scholar 

  21. Piper MA, Evans CV, Burda BU, Margolis KL, O’Connor E, Whitlock EP. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162(3):192–204.

    Article  PubMed  Google Scholar 

  22. Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH. How common is white coat hypertension? JAMA. 1988;259:225–8.

    Article  CAS  PubMed  Google Scholar 

  23. Pickering TG, Davidson K, Gerin W, Schwartz JE. Masked hypertension. Hypertension. 2002;40(6):795–6.

    Article  CAS  PubMed  Google Scholar 

  24. Papadakis JA, Mikhailidis DP, Vrentzos GE, Kalikaki A, Kazakou I, Ganotakis ES. Effect of antihypertensive treatment on plasma fibrinogen and serum HDL levels in patients with essential hypertension. Clin Appl Thromb Hemost. 2005;11:139–46.

    Article  CAS  PubMed  Google Scholar 

  25. Eguchi K, Pickering TG, Schwartz JE, et al. Short sleep duration as an independent predictor of cardiovascular events in Japanese patients with hypertension. Arch Intern Med. 2008;168:2225–31.

    Article  PubMed  Google Scholar 

  26. Manni R, Politini L, Ratti MT, Tartara A. Sleepiness in obstructive sleep apnea syndrome and simple snoring evaluated by the Epworth Sleepiness Scale. J Sleep Res. 1999;8:319–20.

    Article  CAS  PubMed  Google Scholar 

  27. Fierro-Carrion GA, Ram CV. Nonsteroidal anti-inflammatory drugs (NSAIDs) and blood pressure. Am J Cardiol. 1997;80:775–6.

    Article  CAS  PubMed  Google Scholar 

  28. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology. 1996;46:1470.

    Google Scholar 

  29. Singh P, Aronow WS, Mellana WM, Gutwein AH. Prevalence of appropriate management of diabetes mellitus in an academic general medicine clinic. Am J Ther. 2009;17(1):42–5.

    Article  Google Scholar 

  30. van der Velde M, Halbesma N, DeCharro FT, et al. Screening for albuminuria identifies individuals at increased renal risk. J Am Soc Nephrol. 2009;20:852–62.

    Google Scholar 

  31. Hillege HL, Fidler V, Diercks GF, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation. 2002;106:1777–82.

    Article  CAS  PubMed  Google Scholar 

  32. Gerstein HC, Mann JF, Yi Q, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA. 2001;286:421–6.

    Article  CAS  PubMed  Google Scholar 

  33. Onusko E. Diagnosing secondary hypertension. Am Fam Physician. 2003;67:67–74.

    PubMed  Google Scholar 

  34. Aurell M. Screening for secondary hypertension. Curr Hypertens Rep. 1999;1:461.

    Article  CAS  PubMed  Google Scholar 

  35. Fletcher EC, DeBehnke RD, Lovoi MS, Gorin AB. Undiagnosed sleep apnea in patients with essential hypertension. Ann Intern Med. 1985;103:190–5.

    Article  CAS  PubMed  Google Scholar 

  36. Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke. 2006;37:967–72.

    Article  PubMed  Google Scholar 

  37. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet. 2002;359:204–10.

    Article  PubMed  Google Scholar 

  38. Qaseem A, Dallas P, Owens DK, Starkey M, Holty JC, Shekelle P, et al. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161:210–20. doi:10.7326/M12-3187.

    Article  PubMed  Google Scholar 

  39. Farkouh ME, Verheugt FW, Ruland S, et al. A comparison of the blood pressure changes of lumiracoxib with those of ibuprofen and naproxen. J Clin Hypertens (Greenwich). 2008;10:592–602.

    Article  CAS  Google Scholar 

  40. Panoulas VF, Douglas KM, Stavropoulos-Kalinoglou A, et al. Long-term exposure to medium-dose glucocorticoid therapy associates with hypertension in patients with rheumatoid arthritis. Rheumatology (Oxford). 2008;47:72–5.

    Article  CAS  Google Scholar 

  41. Shufelt CL, Bairey Merz CN. Contraceptive hormone use and cardiovascular disease. J Am Coll Cardiol. 2009;53:221–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Taneja I, Diedrich A, Black BK, Byrne DW, Paranjape SY, Robertson D. Modafinil elicits sympathomedullary activation. Hypertension. 2005;45:612–8.

    Article  CAS  PubMed  Google Scholar 

  43. Idelevich E, Kirch W, Schindler C. Current pharmacotherapeutic concepts for the treatment of obesity in adults. Ther Adv Cardiovasc Dis. 2009;3:75–90.

    Article  PubMed  Google Scholar 

  44. Kisely S, Cox M, Campbell LA, Cooke C, Gardner D. An epidemiologic study of psychotropic medication and obesity-related chronic illnesses in older psychiatric patients. Can J Psychiatry. 2009;54:269–74.

    PubMed  Google Scholar 

  45. Johnson EM, Whyte E, Mulsant BH, et al. Cardiovascular changes associated with venlafaxine in the treatment of late-life depression. Am J Geriatr Psychiatry. 2006;14:796–802.

    Article  PubMed  Google Scholar 

  46. Krapf R, Hulter HN. Arterial hypertension induced by erythropoietin and erythropoiesis-stimulating agents (ESA). Clin J Am Soc Nephrol 2009;4(2):470–480.

    Google Scholar 

  47. Kramer BK, Boger C, Kruger B, et al. Cardiovascular risk estimates and risk factors in renal transplant recipients. Transplant Proc. 2005;37:1868–70.

    Article  CAS  PubMed  Google Scholar 

  48. Baekken M, Os I, Sandvik L, Oektedalen O. Hypertension in an urban HIV-positive population compared with the general population: influence of combination antiretroviral therapy. J Hypertens. 2008;26:2126–33.

    Article  CAS  PubMed  Google Scholar 

  49. Templin C, Westhoff-Bleck M, Ghadri JR. Hypokalemic paralysis with rhabdomyolysis and arterial hypertension caused by liquorice ingestion. Clin Res Cardiol. 2009;98:130–2.

    Article  PubMed  Google Scholar 

  50. Urbina A, Jones K. Crystal methamphetamine, its analogues, and HIV infection: medical and psychiatric aspects of a new epidemic. Clin Infect Dis. 2004;38:890–4.

    Article  PubMed  Google Scholar 

  51. Gahlinger PM. Club drugs: MDMA, gamma-hydroxybutyrate (GHB), Rohypnol, and ketamine. Am Fam Physician. 2004;69:2619–26.

    PubMed  Google Scholar 

  52. Veronese ML, Mosenkis A, Flaherty KT, et al. Mechanisms of hypertension associated with BAY 43-9006. J Clin Oncol. 2006;24:1363–9.

    Article  CAS  PubMed  Google Scholar 

  53. Bono P, Elfving H, Utriainen T, et al. Hypertension and clinical benefit of bevacizumab in the treatment of advanced renal cell carcinoma. Ann Oncol. 2009;20:393–4.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Renal Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA

    Raymond R. Townsend M.D.

  2. Devision of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA

    Susan P. Steigerwalt M.D., F.A.S.H., F.A.C.P.

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  1. Raymond R. Townsend M.D.
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  2. Susan P. Steigerwalt M.D., F.A.S.H., F.A.C.P.
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Correspondence to Susan P. Steigerwalt M.D., F.A.S.H., F.A.C.P. .

Editor information

Editors and Affiliations

  1. Departments of Neurological Surgery and Neurology and Neurotherapeutics , University of Texas Southwestern Medical Center , Dallas, Texas, USA

    Venkatesh Aiyagari

  2. Michigan State University Department of Translational Science & Molecular Medicine, Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan, USA

    Philip B. Gorelick

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Townsend, R.R., Steigerwalt, S.P. (2016). Blood Pressure: Definition, Diagnosis, and Management. In: Aiyagari, V., Gorelick, P. (eds) Hypertension and Stroke. Clinical Hypertension and Vascular Diseases. Humana Press, Cham. https://doi.org/10.1007/978-3-319-29152-9_1

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  • DOI: https://doi.org/10.1007/978-3-319-29152-9_1

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