Hypertension: Diagnosis, Grading & Management

Blood pressure Diagnosis, Grading and Management

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Initiation of blood pressure-lowering treatment (lifestyle changes and medication) at different initial office blood pressure levels
Abbreviations: BP = blood pressure; CAD = coronary artery disease; CVD = cardiovascular disease; HMOD = hypertension-mediated organ damage. Adapted from: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) European Heart Journal (2018) 39, 3021–3104.

How to measure blood pressure (BP)
Patients should be seated comfortably in a quiet environment for 5 minutes before beginning BP measurements. Three BP measurements should be recorded, 1-2 min apart, and additional measurements only if the first two readings differ by >10 mmHg. BP is recorded as the average of the last two BP readings. Use a standard bladder cuff (12-13 cm wide and 35 cm long) for most patients but have larger and smaller cuffs available for larger (arm circumference > 32 cm) and thinner arms, respectively.
Hypertension in clinic should be confirmed with home BP measurement or 24hr ambulatory BP monitoring if a white coat effect is evoked.

2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement: European Society of Hypertension Council and the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens. 2021 Jul 1;39(7):1293-1302. Stergiou et al.

Comparison of ambulatory blood pressure monitoring (24h ABPM) and home blood pressure monitoring (HBPM)

• Can identify white coat and masked hypertension
• Night time readings
• Real life setting
• BP variability
• Prognosis value (no deeper)
• Suspicion of sleep apnea syndrome (no deeper)
• Can identify white coat and masked hypertension
• Cheap and widely available
• Patient engagement in BP measurement
• Easily repeated
• Expensive
• Sometimes uncomfortable
• Only static BP
• Potential measurement error
• No nocturnal readings

Where available, please refer to national hypertension guidelines for further information.