JNC 7 Hypertension Workup

1
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 lt 180/110 mmHg
• not specified in JNC 7

2
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

3
CVD Risk Factors (JNC 7)

• Hypertension
• Cigarette smoking
• Obesity (BMI gt 30)
• Physical inactivity
• Dyslipidemia
• Diabetes

• Microalbuminuria (30-300 mg/d) or estimated GFR lt
  60 ml/min
• Age (gt55 in men or gt65 in women)
• Family history of premature CVD (lt55 in men or
  lt65 in women)

4
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

5
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)

6
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 ß-blockers) allows LVH regression