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Patients
with hypertension are usually symptom-free. Blood pressure elevation may
be discovered during periodic health examinations, or may represent a serendipitous
finding. Because pressures obtained on repeated measurements are extremely
variable, mislabeling individuals as 'hypertensive' or 'normotensive' is
a potential hazard. If mislabeled normotensive, treatment delay may increase
risk of cardiovascular disease; if mislabeled 'hypertensive', unnecessary
therapy may inflict dangerous side effects and pointless expense. The approach
to an individual with hypertension begins with the determination of whether
hypertension is present or the individual is mislabeled. Guidelines for
the measurement of blood pressure and the diagnosis of hypertension are
given below (Note
1). Because of "white-coat" hypertension, it may be necessary to obtain
blood pressure readings outside the physician's office. |
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| Note
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Given
BP measurement variability, precautions intended to prevent mislabeling
of patients are vital.
Position:
Measure BP after the patient has been sitting for at least 5 minutes, the
arm supported at the level of the heart. To assess postural changes, if
indicated, take pressure after 5 minutes in the supine position, then immediately
on standing, and 2 minutes later.
Setting:
No caffeine, no smoking, no adrenergic stimulants; if the temperature outside
is cold, patient should be given opportunity to be warm.
Apparatus:
Cuff bladder encircles and covers 2/3 of arm length, bladder over brachial
artery.
Method:
Take at least two readings at each visit, separated by as much time as
possible, three sets of readings at least 1 week apart. Take pressure in
both arms and if different, use higher pressure arm. In patients <30
years of age, take pressure in one leg. Inflate bladder quickly to 20 mm.
Hg. above systolic measured by radial pulse obliteration, and deflate at
a rate of 3 mm. Hg./sec. The World Health Organization defines hypertension
as BP consistently higher than 140/90 mm Hg.
Definitions:
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Optimal
BP: <120/<80 mm Hg
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Normal
BP: 120-129/80-84 mm Hg
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High-normal
BP: 130-139/85-89 mm Hg
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Hypertension:
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Stage
1: 140-159/90-99 mm Hg
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Stage
2: 160-179/100-109 mm Hg
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Stage
3: 179-209/110-119 mm Hg
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Stage
4: >210/>120 mm Hg
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