The guide to cardiology: Evaluation and management of hypertension

Data from the National Health and Nutrition Examination Survey indicate that approximately 58 million Americans are at increased risk for morbidity and premature death from high blood pressure. Effective treatment for hypertension requires measurement of the blood pressure at more than one office visit, with home blood-pressure recording another useful technique and 24-hour blood-pressure monitoring seeing increased use. Evaluation of the patient also requires a search for evidence of end-organ damage, atherosclerotic disease, and examination of the femoral pulse for a pulse delay. Laboratory testing includes examination for such risk factors as blood sugar elevation and a high serum cholesterol level, as well as electrocardiography. Owing to its potentially serious consequences, malignant hypertension requires rapid recognition and management. Secondary hypertension may result from renovascular disease, primary aldosteronism, Cushing's syndrome, and hyperthyroidism, among other sources, each of which can be identified by the appropriate use of screening methods. In addition to weight loss, sodium and alcohol restriction, cessation of smoking, and other nonpharmacologic means of management, the treatment of renovascular hypertension can today be effected with a wide range of agents including alpha- and β-blocking agents, angiotensin-converting-enzyme inhibitors, and calcium-channel-blocking agents in addition to sympatholytic agents and thiazide diuretics.

Duke Scholars

Author Victor J. Dzau Medicine, Cardiology