Asymptomatic hypertension

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Background

  • JNC 7 recommends 2 or more properly measured, seated blood pressure readings on each of 2 or more office visits to establish the diagnosis of hypertension[1]

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
  • JNC-8 Changes: In patients ≥60 yr the threshold has increased from <140/90 to <150/90[2]

Clinical Features

  • None (asymptomatic by definition)

Differential Diagnosis

Hypertension

Evaluation

  • Upreg
  • <120 diastolic
    • No screening ED workup --> home with outpatient treatment
  • >210 systolic or >120-130 diastolic
    • Chem 7 (creatinine) --> home with outpatient treatment if no evidence of acute renal failure
      • "No other diagnostic screening tests (e.g. UA, ECG) appear to be useful"[3]
Routine screening for acute target organ injury (e.g. creatinine, UA, ECG) is NOT required (Level C)[3]
In select patient populations, screening of creatinine may identify injury that affects disposition (Level C)[3]

Management

JNC 8 Recommendations[2]

Population Non-black Patients Black Patients
General population thiazide, CCB, ACEI, or ARB thiazide or CCB
CKD ACEI or ARB ACEI or ARB
DM thiazide, CCB, ACEI, or ARB thiazide or CCB
Routine ED medical intervention is NOT required (Level C)[3]
In select patient populations, physicians may treat markedly elevated blood pressure in the ED and/or initiate therapy for long-term control (Level C)[3]
Patients should be referred for outpatient follow up (Level C)[3]

Disposition

See Also

References

  1. Chobanian AV, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure - The JNC 7 Report. JAMA. 2003; 289(19):2560-2572.
  2. 2.0 2.1 James PA, et al. 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):507-520.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 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 Asymptomatic Hypertension. Annals of Emergency Medicine. 2013; 62(1):59-63.