Definitions
and classification of office blood pressure levels (mmHg)
Systolic (mm
Hg)
|
Diastolic (mm
Hg)
|
|||
Optimal
|
<120
|
and
|
<80
|
|
Normal
|
121-129
|
and/or
|
80-84
|
|
High normal
|
130-139
|
and/or
|
85-89
|
|
Grade 1
Hypertension
|
140-159
|
and/or
|
90-99
|
|
Grade 2
Hypertension
|
160-179
|
and/or
|
100-109
|
|
Grade 3
Hypertension
|
≥ 180
|
and/or
|
≥110
|
|
Isolated
Systolic Hypertension*
|
≥ 140
|
and
|
<90
|
*Isolated systolic
hypertension should be graded 1, 2, or 3 according to systolic BP values in the
ranges indicated.
Worldwide, 1.5 billion people currently have high
blood pressure, according to the World
Health Organization. Hypertension is defined as values ≥140 mmHg SBP
and/or ≥90 mmHg DBP, based on the evidence from RCTs that in patients with
these BP values treatment-induced BP reductions are beneficial. Prompt initiation of drug treatment is
recommended in individuals with grade 2 and 3 hypertension with any level of CV
risk, a few weeks after or simultaneously with initiation of lifestyle changes. Lowering BP with drugs is also recommended when
total CV risk is high because of OD, diabetes, CVD or CKD, even when
hypertension is in the grade 1 range. Unless the necessary evidence is obtained it is
not recommended to initiate antihypertensive drug therapy at high normal BP. According to the new guidelines of
European Society
of Hypertension (ESH) and the European
Society of Cardiology (ESC) for the management of hypertension,
simplifying treatment decisions for physicians with the recommendation that all
patients be treated to <140 mm Hg systolic blood pressure.
A DBP
target of <90 mmHg is always recommended.
The new guidelines do make exceptions for special
populations, such as those with diabetes and the elderly. For those with diabetes,
the ESH/ESC writing committee recommend that physicians treat patients to
<85 mm Hg (80-85 mm Hg) diastolic blood pressure. Lack of evidence does also not allow recommending
to initiate antihypertensive drug therapy in young individuals withisolated
elevation of brachial SBP, but these individuals should be followed closely
with lifestyle recommendations. Blood pressures exceeding 140/90 mm Hg increase
the risk of cardiovascular disease and stroke. The Systematic Coronary Risk
Evaluation (SCORE) known as heart score model has been developed to estimates the risk of dying from CV
(not just coronary) disease over 10 years based on age, gender, smoking habits,
total cholesterol and SBP. A SBP of ≥210 mmHg for men and ≥190 mmHg for
women has been termed ‘exercise hypertension’ in a number of studies. In the
case of normal resting BP,exercise-induced hypertension can be considered an
indication for ABPM because of its association with masked hypertension. It is recommended that the diagnosis of hypertension
be based on at least two BPmeasurements per visit and on at least two visits. On
at least one occasion, BP needs to be measured at both arms and differences
between the two arms in SBP >20 mmHg and/or in DBP > 10 mmHg—if
confirmed—should trigger further investigations of vascular abnormalities.
Definitions
of hypertension by office & out-of-office blood pressure levels
Systolic
(mm Hg)
|
Diastolic (mm Hg)
|
|||
Office BP
|
≥140
|
and
|
≥90
|
|
Ambulatory BP
|
||||
Daytime(or awake)
|
≥135
|
and/or
|
≥85
|
|
Nighttime(or asleep )
|
≥120
|
and/or
|
≥70
|
|
24 hour
|
≥130
|
and/or
|
≥80
|
|
Home BP
|
≥
135
|
and/or
|
≥85
|
Role of out of office B.P (ambulatory or home blood-pressure
monitoring):
2013
guidelines are the first to consider out-of-office blood-pressure monitoring
which provides a large number of measurements outside the medical environment which
represents a more reliable assessment of actual BP than office BP.
Out-of-office BP is commonly assessed by ABPM or HBPM usually by
self-measurement.
ABPM:Patient
wearing a portable BP measuring device, usually on the non-dominant arm, for a
24-25 h period, so that it gives information on BP during daily activities and
at night during sleep.
HBPM:
BP should be measured daily on at least 3 – 4 days and preferably on 7
consecutive days; in the mornings as well as in the evenings.
Source:
Dr.Qurat-ul-Ain Hafeez, Pharm-D, RPh.
Ambulatory Care Pharmacist, Aga khan University Hospital, Karachi , Pakistan
Facebook: Qurat Hafeez
Written by Unknown
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