Chronic hypertension classification: Difference between revisions

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==Overview==
==Overview==
The Joint National Committee seventh report (JNC 7) defines hypertension as a [[systolic blood pressure]] of over 140 mm Hg or a [[diastolic blood pressure]] greater than 90 mm Hg based upon the average of two or more properly measured readings at each of two or more visits after an initial screen<ref name="pmid12748199">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12748199 }} </ref>. Hypertension can be classified as either '''essential''' (primary) or '''secondary'''. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. [[Secondary hypertension]] indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as [[kidney disease]] or certain [[tumor]]s (especially of the [[adrenal gland]]).
[[Blood pressure]] values for adults have been classified in 2004 according to the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure into normal, prehypertension, stage 1 hypertension and stage 2 hypertension<ref name="pmid16512265">{{cite journal| author=Cuddy ML| title=Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1). | journal=J Pract Nurs | year= 2005 | volume= 55 | issue= 4 | pages= 17-21; quiz 22-3 | pmid=16512265 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16512265  }} </ref>. In Europe, a different classification of blood pressure has been conducted in 2007 by “The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)”<ref name="pmid18327095">{{cite journal| author=Bonny A, Lacombe F, Yitemben M, Discazeaux B, Donetti J, Fahri P et al.| title=The 2007 ESH/ESC guidelines for the management of arterial hypertension. | journal=J Hypertens | year= 2008 | volume= 26 | issue= 4 | pages= 825; author reply 825-6 | pmid=18327095 | doi=10.1097/HJH.0b013e3282f857e7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18327095 }} </ref>. The classification excludes JNC 7’s pre-hypertension category, but includes 3 different grades of hypertension, in contrast to JNC 7’s two-stage classification of hypertension.


==Classification==
==Classification==

Revision as of 17:08, 9 March 2013

Hypertension Main page

Overview

Causes

Classification

Primary Hypertension
Secondary Hypertension
Hypertensive Emergency
Hypertensive Urgency

Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Taylor Palmieri

Overview

Blood pressure values for adults have been classified in 2004 according to the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure into normal, prehypertension, stage 1 hypertension and stage 2 hypertension[1]. In Europe, a different classification of blood pressure has been conducted in 2007 by “The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)”[2]. The classification excludes JNC 7’s pre-hypertension category, but includes 3 different grades of hypertension, in contrast to JNC 7’s two-stage classification of hypertension.

Classification

JNC Classification of Severity

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure[3] has classified blood pressure in the follows:

Blood Pressure Classification Systolic (mm Hg) Diastolic (mm Hg)
Normal < 120 and < 80
Pre-Hypertension 120-139 or 80-89
Stage 1 Hypertension 140-159 or 90-99
Stage 2 Hypertension >160 or >100

Pre-hypertension is not a disease category; rather, it is a designation chosen to identify individuals at high risk of developing hypertension. It is not clear if treatment of pre-hypertension would improve outcomes. In patients with diabetes mellitus or kidney disease, a blood pressure > 130/80 mmHg should be considered elevated and may warrant treatment.

Classification of Pathophysiology

Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes.

Essential Hypertension

Essential hypertension is the most prevalent type of hypertension type, and affects 90-95% of hypertensive patients. Although there are risk factors for essential hypertension (sedentary lifestyle, obesity, increased salt intake, increased alcohol intake), by definition there is no other disease state responsible for the occurrence of the elevated blood pressure.

Secondary Hypertension

Secondary hypertension results from an identifiable cause. Recognition of secondary hypertension is critical since the management is different than primary or essential hypertension and involves treatment of the underlying cause of the elevated blood pressure. Underlying disorders that account for secondary hypertension include:

References

  1. Cuddy ML (2005). "Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1)". J Pract Nurs. 55 (4): 17–21, quiz 22-3. PMID 16512265.
  2. Bonny A, Lacombe F, Yitemben M, Discazeaux B, Donetti J, Fahri P; et al. (2008). "The 2007 ESH/ESC guidelines for the management of arterial hypertension". J Hypertens. 26 (4): 825, author reply 825-6. doi:10.1097/HJH.0b013e3282f857e7. PMID 18327095.
  3. Chobanian AV; et al. (2003). "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report". JAMA. 289: 2560–72. PMID 12748199.
  4. Luma GB, Spiotta RT (2006). "Hypertension in children and adolescents". Am Fam Physician. 73 (9): 1558–68. PMID 16719248. Unknown parameter |month= ignored (help)

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