Asymptomatic hypertension

JNC-7 Classification

Class	Systolic		Diasolic
Normal	<120	and	<80
Pre-hypertension	120-130	or	80-89
Stage 1	140-150	or	90-99
Stage 2	≥160	or	≥100

Work-Up

1. Upreg
2. <120 diastolic --> home, outpt rx
3. >210 systolic or >120-130 diastolic --> search end organ
   1. Chem 7 (creatinine)
   2. UA (protein)?
   3. ECG?

Note:

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends an average of 2 or more properly measured, seated blood pressure readings on each of 2 or more office visits to establish the diagnosis

Treatment

1. First line for people without comorbidities: HCTZ 12.5mg, max 25mg (need labs before starting, does not work in people with CKD)
2. First line for people with DM and/or Proteinuria: ACEi/ARB: Lisinopril either Qday or BID but need Chem 10 before and after starting to check for hyperK and Cr.
3. Anyone with CAD, CHF: Beta-Blocker (don't need labs)
4. Amlodipine for anyone, except for people with LE edema (don't need labs)
5. Diltiazem for proteinuria in people unable to tolerate ACEi (don't need labs)
6. Lasix for CHF and/or lower ext edema 2/2 proteinuria