Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

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 established risk factors for cardiovascular disease".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 29, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Siu AL, U.S. Preventive Services Task Force. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015; 163:778.
  2. Harris KC, Benoit G, Dionne J, et al. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, and Assessment of Risk of Pediatric Hypertension. Can J Cardiol 2016; 32:589.
  3. Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:2935.
  4. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation 2008; 118:e714.
  5. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560.
  6. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:2889.
  7. Egan BM, Li J, Qanungo S, Wolfman TE. Blood pressure and cholesterol control in hypertensive hypercholesterolemic patients: national health and nutrition examination surveys 1988-2010. Circulation 2013; 128:29.
  8. O'Brien E, Beevers G, Lip GY. ABC of hypertension. Blood pressure measurement. Part III-automated sphygmomanometry: ambulatory blood pressure measurement. BMJ 2001; 322:1110.
  9. Dasgupta K, Quinn RR, Zarnke KB, et al. The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol 2014; 30:485.
  10. Senior R, Monaghan M, Becher H, et al. Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: a critical appraisal. Supported by the British Society of Echocardiography. Heart 2005; 91:427.
  11. Forman JP, Choi H, Curhan GC. Uric acid and insulin sensitivity and risk of incident hypertension. Arch Intern Med 2009; 169:155.
  12. Laragh J. Laragh's lessons in pathophysiology and clinical pearls for treating hypertension. Am J Hypertens 2001; 14:603.
  13. Egan BM, Basile JN, Rehman SU, et al. Plasma Renin test-guided drug treatment algorithm for correcting patients with treated but uncontrolled hypertension: a randomized controlled trial. Am J Hypertens 2009; 22:792.
  14. Egan BM, Laken MA, Sutherland SE, et al. Aldosterone Antagonists or Renin-Guided Therapy for Treatment-Resistant Hypertension: A Comparative Effectiveness Pilot Study in Primary Care. Am J Hypertens 2016; 29:976.
  15. Kivimäki M, Batty GD, Singh-Manoux A, et al. Validating the Framingham Hypertension Risk Score: results from the Whitehall II study. Hypertension 2009; 54:496.
  16. Vasan RS. A risk score for risk factors: rationale and roadmap for preventing hypertension. Hypertension 2009; 54:454.
  17. Pursnani A, Massaro JM, D'Agostino RB Sr, et al. Guideline-Based Statin Eligibility, Coronary Artery Calcification, and Cardiovascular Events. JAMA 2015; 314:134.
  18. Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009; 27:2121.
  19. Bakris GL, Molitch M. Microalbuminuria as a risk predictor in diabetes: the continuing saga. Diabetes Care 2014; 37:867.