Evaluation of the patient with hypertension
Hypertension is a disease that is not usually accompanied by any symptoms; Headache is the most common symptom of high blood pressure, especially in patients who are aware of their condition. Such patients also often suffer from symptoms of anxiety about the disease or its consequences, regardless of the severity of the blood pressure. Other symptoms related to blood vessels are nosebleed, dizziness and fainting, which are not related to the severity of blood pressure. As a result, most patients will be referred in this context due to random measurement, either as a routine follow-up or as part of blood pressure measurement due to a completely different subject.
The first task is, therefore, to establish the diagnosis of hypertension.
The severity of blood pressure
Classification of systolic and diastolic blood pressure:
Preferred blood pressure < 120 and < 80
Blood pressure that requires follow-up 120-139 and/or 80-89
Level 1 (light) 140-159 and/or 90-99
Level 2 (intermediate) 160-179 and/or 100-109
Level 3 hypertension (severe) >180 and/or >110
Systolic blood pressure >140 and <90 ° C
In blood pressure classification, both the systolic value and the diastolic value should be considered, with the severity determined by the higher of the two.
Defining Hypertension in the clinic
Determination of the blood pressure value and its severity is based on an average of at least 3 measurements made at a difference of one week between measurement and measurement.
The right way to measure blood pressure in a clinic:
The blood pressure should be measured while sitting, after at least 5 minutes of rest, with the hand being supported and the cuff tied to the upper arm at the height of the heart.
Do not smoke a cigarette and do not drink coffee or alcohol half an hour before the test.
A normal blood pressure machine, with a standard sleeve (12-13 cm wide and 35 cm long) should be used. In obese patients or with considerable muscular excess, with a thick arm, a wide sleeve should be used.
If an automatic device is used, 2 consecutive measurements should be performed on each test, 1-2 minutes apart. When a large gap is obtained between the results of the two measurements, a third measurement must be made and the average of the last two measurements should be taken.
On the first visit, the blood pressure in both arms should be measured. The highest value is the one that counts. Be sure to always measure blood pressure in the same arm.
It is recommended to measure blood pressure both in lying and standing in any newly diagnosed patient with hypertension (HTN), in patients over the age of 65 and in diabetic patients.
The blood pressure values measured should be recorded and the position of the subject, the arm being tested, and the sleeve type (standard / wide) should be specified. The target value of the blood pressure to which the patient should be present should be noted.
Definition of hypertension in home measurement
The average value of 135/85 mmHg or above at home measurments (equivalent to an average blood pressure above 140/90 mmHg at the clinic) is considered as hypertension.
Defining hypertension in blood pressure monitoring for 24 hours
Ambulatory blood pressure measured in 24-hour monitoring usually shows values lower than those measured in the clinic, and are even lower than those measured by the patient at home. Therefore, the situation requires a separate definition of a valid range of values. Also, the fact that blood pressure drops by 10-20% during sleep ('dipping') requires separate settings for daytime (wakefulness) and night (sleep). An average blood pressure higher than 135/85 mmHg while awake and higher than 120/75 during sleep is defined as hypertension.
Once the blood pressure has been diagnosed and the degree of severity has been determined, a full and assessment of all aspects of the disease is to be performed.
Goals of assessment in patients with hypertension
· Assess injury to target organs.
· Assess the presence of other risk factors that affect cardiovascular disease
· Secondary HTN
· To detect related diseases that can affect the prognosis and treatment
Special attention should be paid to the following:
· When was the last measured blood pressure?
· Changes in blood pressure values over time
· Was there a previous treatment for hypertension?
· What medications were given as a treatment and in what dosage? Were there any side effects?
· Drugs and substances use that can cause high blood pressure
o Hormonal therapy
o Non-steroidal anti-inflammatory drugs
o Ointments, nose drops or eye drops, containing steroids
o Psychiatric drugs
· Family History
o Are there cases of HTN in family?
o Are there family members that have had early cardiovascular disease or death?
o Are there diseases in the family, such as: Pheohromocytoma, kidney disease such as polycystic kidney disease, diabetes, gout?
· Are there secondary HTN signs?
o muscle weakness
o Fast pulse beats, sweating, trembling
o Thin skin
o Flank pain
o Daytime sleepiness
· Are there signs of damage to the target organs?
o Headaches, dizziness
o weakness or transient blindness
o Loss of visual acuity
o Signs of coronary heart disease (chest pain(
o Signs of heart failure (shortness of breath(
o Intermittent limping
· Are there other risk factors?