Hypertension: Diagnosis & Initial Management
Why is this important?
The prevalence of hypertension is high, with the risk rising as people age. The risk of elevated blood pressure is significant and is a leading cause of preventable death due to cardiovascular disease. Many people are unaware that they have hypertension and even among those who do, less than half are treated to the recommended target levels.
- Hypertension was the leading cause of death and disability worldwide in 2010.
- In the US it is 2nd only to tobacco use as a preventable cause of death for any reason.
- During 2015–2016, the prevalence of hypertension was 29% and increased with age to 63% among individuals 60 and over. The rates varied by race, highest among non-Hispanic blacks (40%). The rate of effectively controlled hypertension was only 48%.3 Many individuals are also not aware that they have hypertension. The lifetime risk of developing hypertension varies by race/ethnicity and is higher among African Americans (93%) and Hispanics (92%) than for whites (86%) and Asians (84%).
How will these tools help?
The risk of cardiovascular disease (CVD) increases exponentially beginning from SBP levels of 115 mm Hg and DBP levels of 75 mm Hg. Every 20 mm Hg rise in SBP or 10 mm Hg rise in DBP is associated with a doubling in the risk of death from stroke, heart disease or other vascular diseases. Effective blood pressure management has been shown to decrease the incidence of stroke, heart attack, and heart failure.
- Recognize essential hypertension in patients not yet formally diagnosed with the condition.
- Engage patients as partners to reduce risk and improve hypertension control (e.g., shared decision making on approach and setting goals based on patient values, preferences, outcomes).
- Connect clinicians, patients, and families to a variety of resources for information and support about healthy behaviors.
- Understand the options for initiating pharmacologic therapy, if necessary, the goals of therapy and how to counsel patients on the importance of medication adherence.
Practice Advisor Content Manager
Jillian Schneider, MHA, Manager Practice Support, American College of Physicians
Lawrence Ward, MD, MPH, FACP, Executive Vice Chairman of Medicine, Thomas Jefferson University Hospital
Beverly Johnson, BSN, President and Chief Executive Officer, Institute for Patient and Family Centered Care
Mary Minniti, CPHQ, Senior Policy and Programs Specialist, Institute for Patient and Family Centered Care
Cynthia (Daisy) Smith, MD, FACP, Vice President, Clinical Programs, American College of Physicians
ACP Staff Editors
Monica Lizarraga, MPH, Grants Administrator
Disha Patel, Practice Support Coordinator
Cheryl Rusten, MPA, Programs and Grants Manager
Margo Williams, MHA, Senior Associate, Medical Practice
The following have disclosed relationships with commercial companies or organizations:
Cynthia (Daisy) Smith, MD
Stock holdings/stock options with Merck. Spouse works for Merck.
All other individuals listed (manager, contributors, editors) have nothing to disclose.
Continuing Medical Education
The American College of Physicians (ACP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education (CME) for physicians.
The ACP designates this CME activity for a maximum of 20 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 20 medical knowledge and practice assessment MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credit claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
Release Date: 8/1/2018
Termination Date: 8/1/2021
To earn CME credits, you must attest after completion of the second module biopsy that you have:
- Participated in the completion of the ACP Practice Biopsy
- Participated in the review of the ACP Practice Biopsy result
- Participated in identifying an action plan to improve our practice
- Participated in the implementation of the plan
- Participated in the follow up ACP Practice Biopsy to measure improvement
When you have done so, follow the on-screen instructions to complete and submit the submission form.
- 20.00 AMA PRA Category 1 Credit™
- 1.00 Attendance
- 20.00 ABIM MOC