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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?


Figure 23-1.

Approach to testing for secondary causes of hypertension. (Reproduced with permission from Whelton PK, Carey RM, Aronow WS, et al: ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, Hypertension. 2018 Jun;71(6):e13–e115.)

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 ...

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