1 / 6

JNC 7 Hypertension Work-up

JNC 7 Hypertension Work-up. Patients should be evaluated to: Identify other cardiovascular risk factors (cholesterol, glucose, smoking, gender, menopausal status, age) Assess target organs (heart, brain kidney, peripheral arteries) Exclude secondary forms of hypertension

teenie
Download Presentation

JNC 7 Hypertension Work-up

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. JNC 7 Hypertension Work-up • Patients should be evaluated to: • Identify other cardiovascular risk factors (cholesterol, glucose, smoking, gender, menopausal status, age) • Assess target organs (heart, brain kidney, peripheral arteries) • Exclude secondary forms of hypertension • Provide baseline for follow-up* • Correct BP measurement technique • Confirm BP at another visit if < 180/110 mmHg * not specified in JNC 7

  2. Target Organ Impact Of Hypertension • Heart • Angina/myocardial infarction • Left ventricular hypertrophy • Heart failure • Vasculature • Peripheral arterial disease • Brain • Ischemic stroke • Dementia • Eye • Retinopathy • Kidney • Chronic kidney disease

  3. Hypertension Cigarette smoking Obesity (BMI > 30) Physical inactivity Dyslipidemia Diabetes CVD Risk Factors (JNC 7) • Microalbuminuria (30-300 mg/d) or estimated GFR < 60 ml/min • Age (>55 in men or >65 in women) • Family history of premature CVD (<55 in men or <65 in women)

  4. Plasma renin activity • Limited reliability/reproducibility • Highly variable across the population • Variable within individuals (posture, stress, volume-sensitive, drug effects, etc.) • Low sensitivity/specificity for secondary forms of hypertension • Not tested for risk profiling in the broad population • Costly and cumbersome

  5. 24-hour ABP • Not validated as surrogate in large outcome trials • Diagnostic cutoffs not fully established (135/85?) • Cumbersome, unpleasant • Technically difficult • Often done incorrectly • Problem of data exclusion (artifacts)

  6. Echocardiogram • Not usually abnormal in early hypertension • LV mass calculation usually omitted by cardiologist • Diagnosis of LVH does not affect therapeutic decision-making • Effective BP-lowering therapy with any agent (possibly except β-blockers) allows LVH regression

More Related