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JNC 7 Hypertension Work-up • Patients should be evaluated to: • Identify other cardiovascular risk factors (cholesterol, glucose, smoking, gender, menopausal status, age) • Assess target organs (heart, brain kidney, peripheral arteries) • Exclude secondary forms of hypertension • Provide baseline for follow-up* • Correct BP measurement technique • Confirm BP at another visit if < 180/110 mmHg * not specified in JNC 7
Target Organ Impact Of Hypertension • Heart • Angina/myocardial infarction • Left ventricular hypertrophy • Heart failure • Vasculature • Peripheral arterial disease • Brain • Ischemic stroke • Dementia • Eye • Retinopathy • Kidney • Chronic kidney disease
Hypertension Cigarette smoking Obesity (BMI > 30) Physical inactivity Dyslipidemia Diabetes CVD Risk Factors (JNC 7) • Microalbuminuria (30-300 mg/d) or estimated GFR < 60 ml/min • Age (>55 in men or >65 in women) • Family history of premature CVD (<55 in men or <65 in women)
Plasma renin activity • Limited reliability/reproducibility • Highly variable across the population • Variable within individuals (posture, stress, volume-sensitive, drug effects, etc.) • Low sensitivity/specificity for secondary forms of hypertension • Not tested for risk profiling in the broad population • Costly and cumbersome
24-hour ABP • Not validated as surrogate in large outcome trials • Diagnostic cutoffs not fully established (135/85?) • Cumbersome, unpleasant • Technically difficult • Often done incorrectly • Problem of data exclusion (artifacts)
Echocardiogram • Not usually abnormal in early hypertension • LV mass calculation usually omitted by cardiologist • Diagnosis of LVH does not affect therapeutic decision-making • Effective BP-lowering therapy with any agent (possibly except β-blockers) allows LVH regression