Part 1: Diagnosis & Assessment
I ACCURATE MEASUREMENT OF BLOOD PRESSURE 1) Health care professionals who have been specifically trained to measure blood pressure (BP) accurately should assess BP in all adult patients at all appropriate visits to determine cardiovascular risk and monitor antihypertensive treatment (Grade D). 2) Useof standardized measurement techniques (Table 1) is recommended when assessing blood pressure (Grade D). 3) Automated office blood pressure measurements can be used in the assessment of office blood pressure (Grade D). 4) When used under proper conditions, automated office SBP of 135 mmHg or higher or DBP values of 85 mmHg or higher should be considered analogous to mean awake ambulatory SBP of 135mmHg or higher and DBP of 85 mmHg or higher, respectively (Grade D).
II CRITERIA FOR DIAGNOSIS OF HYPERTENSION AND RECOMMENDATIONS FOR FOLLOW-UP 1) At initial presentation, patients demonstrating features of a hypertensive urgency or emergency (Table 2) should be diagnosed as hypertensive and require immediate management (Grade D). 2) If systolic BP (SBP) is >140 mmHg and/or diastolic BP (DBP)is >90 mmHg, a specific visit should be scheduled for the assessment of hypertension (Grade D). If BP is high-normal (SBP 130 - 139 mmHg and/or DBP 85 - 89 mmHg), annual follow-up is recommended (Grade C). 3) At the initial visit for the assessment of hypertension, if SBP is >140 mmHg and/or DBP is >90 mmHg, at least two more readings should be taken during the same visit using a validated deviceand according to the recommended procedure for accurate BP determination (Table 1). The first reading should be discarded and the latter two averaged. A history and physical examination should be performed and, if clinically indicated, diagnostic tests to
2010 CHEP Recommendations for the Management of Hypertension
search for target organ damage (Table 3) and associated cardiovascularrisk factors (Table 4) should be arranged within two visits. Exogenous factors that can induce or aggravate hypertension should be assessed and removed if possible (Table 5). Schedule visit two within one month (Grade D). 4) At visit 2 for the assessment of hypertension, patients with macrovascular target organ damage, diabetes mellitus, or chronic kidney disease (CKD; GFR < 60 ml/min) can bediagnosed as hypertensive if SBP is >140 mmHg and/or DBP is >90 mmHg (Grade D). 5) At visit 2 for the assessment of hypertension, patients without macrovascular target organ damage, diabetes mellitus, and/or chronic kidney disease can be diagnosed as hypertensive if the SBP is >180 mmHg or greater and/or the DBP is >110 mmHg. Patients without macrovascular target organ damage, diabetes mellitus, or CKDbut with lower BP levels should undergo further evaluation using any of the three approaches outlined below: i) Office manual BPs: Using office manual BP measurements, patients can be diagnosed as hypertensive if the SBP is >160 mmHg or the DBP is >100 mmHg averaged across the first 3 visits, or if the SBP averages >140 mmHg or the DBP averages >90 mmHg averaged across 5 visits (Grade D). ii)Ambulatory BP monitoring (ABPM): Using ABPM (see Section VIII), patients can be diagnosed as hypertensive if the mean awake SBP is >135 mmHg or the DBP is >85 mmHg, or if the mean 24 hour SBP is >130 mmHg or the DBP is >80 mmHg (Grade C). iii) Home BP Measurement: Using home BP measurements (see Section VII), patients can be diagnosed as hypertensive if the average SBP is >135 mmHg or the DBP is >85mmHg (Grade C). If the average home BP is less than 135/85 mmHg, it is advisable to perform 24h ABPM to confirm that the mean 24h ABPM is 135 mmHg or DBP values >85 mmHg should be considered elevated and associated with an increased overall mortality risk analogous to office SBP readings of >140 mmHg or DBP >90 mmHg (Grade C). 6) Health care professionals should ensure that patients who measure...