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(Circulation. 2002;105:2458.)
© 2002 American Heart Association, Inc.

Clinician Update

Evaluation and Treatment of Patients With Systemic Hypertension

Jay Garg, MD; Adrian W. Messerli, MD; George L. Bakris, MD

From Rush University Hypertension Center, Department of Preventive Medicine, Rush Presbyterian/St Luke’s Medical Center, Chicago, Ill (J.G., G.L.B.); and Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Cleveland, Ohio (A.W.M.).

Correspondence to George Bakris, MD, Rush Medical Center, 1700 W Van Buren St, Suite 470, Chicago, IL 60612. E-mail gbakris@rush.edu

Key Words: drugs • diabetes mellitus • coronary disease • kidney • aging

	Introduction

 
A 65-year-old man presented for evaluation of high blood pressure found on screening at a local health fair. History and physical examination did not show any signs or symptoms suggestive of a secondary cause, nor was there evidence of target end-organ damage except for grade 1 Keith-Wagener-Barker retinopathy. The patient denied taking any prescription or over-the-counter medications.

Hypertension is the most common disease-specific reason Americans visit a physician. Despite the risks associated with an elevated blood pressure (BP), there is still woefully low achievement of recommended BP goals. From 1991 to 1994, only 27.4% of hypertensive Americans aged 18 to 74 years had a BP <140/90 mm Hg, the current stated goal for most people with hypertension, and in those with diabetes, less than half that number (11%) were controlled to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure VI (JNC VI) recommended goal of <130/85 mm Hg.¹ The present update will provide an overview of the evaluation and management of essential hypertension and help to guide clinicians in developing a management plan for a patient like the one described above.

	Evaluation

 
Taking a proper BP is an important first step in the diagnosis of hypertension.² Using the proper cuff size with patients resting quietly and comfortably (with back support if seated) for at least 5 minutes before measurement, 2 or more readings separated by 2 minutes should be taken and averaged. Initial elevated BP readings should be confirmed on at least 2 subsequent visits . . . [Full Text of this Article]

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