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I HAVE A PATIENT WITH HYPERTENSION

How do I determine the cause?

CHIEF COMPLAINT

PATIENT image

Mr. U is a 48-year-old man with a BP of 155/90 mm Hg.

image What is the differential diagnosis of hypertension? How would you frame the differential?

CONSTRUCTING A DIFFERENTIAL DIAGNOSIS

First, what is normal BP, and when is a patient hypertensive? The first step is accurately measuring the BP. Table 23-1 summarizes guidelines for obtaining valid BP measurements. In addition to measurements taken during office visits, devices that measure BP at home are frequently used. Patients with these devices should be encouraged to bring them to office visits to ensure their accuracy and assess proper BP measurement technique.

Table 23-1.Guidelines for measuring BP.

The 2017 American College of Cardiology–American Heart Association (ACC/AHA) Hypertension Guideline classifies BP as:

  1. Normal: systolic BP < 120 mm Hg and diastolic BP < 80 mm Hg

  2. Elevated: systolic BP 120–129 mm Hg and diastolic BP < 80 mm Hg

  3. Stage 1 hypertension: systolic BP 130– 39 mm Hg or diastolic BP 80–89 mm Hg

  4. Stage 2 hypertension: systolic BP ≥ 140 or diastolic BP ≥ 90 mm Hg

    image Using this definition, the prevalence of hypertension among adults in the United States is approximately 45%.

Hypertension is either primary (essential) or secondary (resulting from ...

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