hypertension,is defined as a systolic blood pressure (SBP) of 140 mm Hg or more or a diastolic blood pressure (DBP) of 90 mm Hg or more or taking antihypertensi

ve medication

Based on recommendations of the JNC 7, the classification of BP (expressed in mm Hg) for adults aged 18 years or older is as follows[4] : Normal: systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg Prehypertension: systolic 120-139 mm Hg, diastolic 80-89 mm Hg Stage 1: systolic 140-159 mm Hg, diastolic 90-99 mm Hg Stage 2: systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater The classification above is based on *the average of 2 or more readings taken at each of 2 or more visits after initi al screening. The Eighth Report of the JNC (JNC 8), released in December 2013, recommends less aggressive target blood pressures and treatment-initiation thresholds than the JNC7 for elderly patients and in patients younger than 60 years with diabetes an d kidney disease, and no longer recommends just thiazide-type diuretics as initi al therapy in most patients.[1, 2] In essence, the JNC 8 recommends treating to 150/90 mm Hg in patients over age 60 years; for everybody else, the goal BP is 1 40/90.[2] Approximately 90-95% of adults with hypertension have primary hypertension, whereas secondary hypertension accounts for around 5-10% of the cases. However, secondary forms of hypertension, such as primary hyperaldosteronism, account for 20% of resistant hypertension **(hypertension in which BP is >140/90 mm Hg despite the use of medications from 3 or more drug classes, 1 of which is a thiazide diuretic).

Especially severe cases of hypertension, or hypertensive crises, *are defined as a BP of more than 180/120 mm Hg *and may be further categorized as hypertensive emergencies or urgencies. Hypertensive emergencies are characterized by evidence of impending or progressi ve target organ dysfunction, whereas hypertensive urgencies are those situations without progressive target o rgan dysfunction In hypertensive emergencies, the BP should be aggressively lowered within minute s to an hour by no more than 25%, and then lowered to 160/100-110 mm Hg within the next 2-6 hours

Various strategies to decrease cardiovascular disease risk include the following : Prevention and treatment of obesity: an increase in body mass index (BMI) and wa ist circumference is associated with an increased risk of developing conditions with high cardiovascular risk, such as hypertension, diabetes mellitus, impaired fasting glucose, and left ventricular hypertrophy [LVH][42] Appropriate amounts of aerobic physical activity Diets low in salt, total fat, and cholesterol Adequate dietary intake of potassium, calcium, and magnesium Limited alcohol consumption Avoidance of cigarette smoking Avoidance of the use of illicit drugs, such as cocaine

Following the documentation of hypertension, which is confirmed after an elevate d blood pressure (BP) *on at least 3 separate occasions (based on the average of 2 or more readings ta ken at each of =2 follow-up visits after initial screening),

The JNC 7 identifies the following as major cardiovascular risk factors[4] : Hypertension: component of metabolic syndrome Tobacco use, particularly cigarettes, including chewing tobacco Elevated LDL cholesterol (or total cholesterol =240 mg/dL) or low HDL cholestero l: component of metabolic syndrome Diabetes mellitus: component of metabolic syndrome Obesity (BMI =30 kg/m2): component of metabolic syndrome Age greater than 55 years for men or greater than 65 years for women: increased risk begins at the respective ages; the Adult Treatment Panel III used earlier a ge cut points to suggest the need for earlier action Estimated glomerular filtration rate less than 60 mL/min Microalbuminuria Family history of premature cardiovascular disease (men < 55 years; women < 65 y ears) Lack of exercise

On the first visit, blood pressure should be checked in both arms and in one leg to avoid missing the diagnosis of coarctation of aorta or subclavian artery ste nosis.

The patient should rest quietly for at least 5 minutes before the measurement. B lood pressure should be measured in both the supine and sitting positions, auscu ltating with the bell of the stethoscope. As the improper cuff size may influenc

e blood pressure measurement, a wider cuff is preferable, particularly if the pa tient s arm circumference exceeds 30 cm. Although somewhat controversial, the comm on practice is to document phase V (a disappearance of all sounds) of Korotkoff sounds as the diastolic pressure.