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Initial evaluation of the hypertensive adult

Brent M Egan, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc


Most hypertensive patients present with a modest elevation in blood pressure (ie, stage 1 hypertension, 140 to 159/90 to 99 mmHg) and no clinical cardiovascular disease or signs of hypertension-related target-organ damage. The diagnosis of hypertension is made in this setting only after an elevated and properly measured blood pressure has been confirmed on multiple occasions or, preferably, if an elevated blood pressure obtained in the office is confirmed by out-of-office measurements (algorithm 1) [1,2]. Establishing the diagnosis of hypertension and the methods of measuring blood pressure are discussed elsewhere. (See "Overview of hypertension in adults", section on 'Diagnosis' and "Blood pressure measurement in the diagnosis and management of hypertension in adults".)

The appropriate management of hypertensive patients, including those with prehypertension, depends upon several factors, including the presence or absence of specific comorbidities, the overall cardiovascular risk, and whether or not the hypertension is being caused by a second, potentially reversible disorder [3]. (See "Choice of drug therapy in primary (essential) hypertension" and "What is goal blood pressure in the treatment of hypertension?" and "Evaluation of secondary hypertension".)

Thus, after the presence of hypertension has been established, an evaluation should be performed to ascertain the following information:

The extent of target-organ damage.

The patient's overall cardiovascular risk status. (See "Overview of the risk equivalents and established risk factors for cardiovascular disease".)


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Literature review current through: Sep 2016. | This topic last updated: Aug 29, 2016.
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