Asymptomatic hypertension: Difference between revisions
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#>210 systolic or >120-130 diastolic --> search end organ | #>210 systolic or >120-130 diastolic --> search end organ | ||
##Chem 7 (creatinine) | ##Chem 7 (creatinine) | ||
##"No other tests (e.g. UA, ECG) appear to be useful"<ref>Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients in the Emergency Department with Asymptomatic Elevated Blood Pressure. ACEP Clinical Policies Subcommittee on Ansymptomatic Hypertension. Annals of Emergency Medicine. Vol 62(1) July 2013 p59-63</ref> | |||
== Treatment == | == Treatment == |
Revision as of 18:18, 8 April 2014
Background
- Joint National Committee (JNC) 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 of hypertension
ACEP 2012 Clinical Policy on Asymptomatic Elevated BP[1]
- Screening
- Routine screening for acute target organ injury (e.g. creatinine, UA, ECG) is NOT required (Level C)
- In select patient populations, screening of creatinine may identify injury that affects disposition (Level C)
- Treatment
- Routine ED medical intervention is NOT required (Level C)
- In select patient populations, physicians may treat markedly elevated blood pressure in the ED and/or initiate therapy for long-term control (Level C)
- Patients should be referred for outpatient follow up (Level C)
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
- Upreg
- <120 diastolic --> home, outpt rx
- >210 systolic or >120-130 diastolic --> search end organ
- Chem 7 (creatinine)
- "No other tests (e.g. UA, ECG) appear to be useful"[2]
Treatment
- First line for people without comorbidities
- HCTZ 12.5mg, max 25mg
- Need labs before starting, does not work in people with CKD
- HCTZ 12.5mg, max 25mg
- First line for people with DM and/or Proteinuria
- ACEi/ARB: Lisinopril either Qday or BID
- Need Chem 10 before and after starting to check for hyperK and Cr
- ACEi/ARB: Lisinopril either Qday or BID
- Anyone with CAD, CHF
- Beta-Blocker (don't need labs)
- Amlodipine for anyone, except for people with LE edema (don't need labs)
- Diltiazem for proteinuria in people unable to tolerate ACEi (don't need labs)
- Lasix for CHF and/or lower ext edema 2/2 proteinuria
See Also
- ↑ Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients in the Emergency Department with Asymptomatic Elevated Blood Pressure. ACEP Clinical Policies Subcommittee on Ansymptomatic Hypertension. Annals of Emergency Medicine. Vol 62(1) July 2013 p59-63
- ↑ Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients in the Emergency Department with Asymptomatic Elevated Blood Pressure. ACEP Clinical Policies Subcommittee on Ansymptomatic Hypertension. Annals of Emergency Medicine. Vol 62(1) July 2013 p59-63