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User Guide Institutional 18.3

1. sS3222 s 4 SMOj e 12 J1 32 M S 2 0 34 19S9 15 UO 3 354 1NOK Dap AOI s3 2l118 D 2 4313431 194 1X31 nJ 91 441 S10 2 INO 0 S 4 U U09 pue s 1011s 1b 1 UgNs 0 NOA smoj e uo ng y gt DeqGQpa a4 s 431 2d 10 sandea jO gt 110A 01 5 do D 13S 0 10K SAOJ e JOO PLu3 s 431 2d 104 Ajjery2ads 439 1UM s2 Jo1 009 3A0 s p1 24 uoleuuloJu 1u lled 3SB 31 Se 84 32uls je 2 ds q s8 1 psy Mau 11e110d u yo Ase u uns e sapiaoid s jJegJ1381B8ue 4 gt 3312214 S3DN I4 4 4M M N S ZLYM Sa gt Aap ayesedas asn 10 sejno 43 4 U3 U9 01 9394 34 84 JEU ul S10 2 79 29 23 Da U 6 9 sS3992 331A01d sio1e n3 e3 40 9219 U 419 4 0 q434 242 J134 0 8 1p 31p 03 8719 sn01 8 sep Ajje 113103 194 yay 0 JP 3 ul 3 MOVE D42 B UP 217 2 4 p Je P 1018 413 4i 311 2 pad 1 15Pe 003 p 1aA0 ID d uo3 x 43 M di ysiauyied 4 aseqezep suol 3e1 lu Snip pue aseqezep 8niq susaysAs p 123 as 4o11e1831u YNI J1 M qel eAe JAD sased 99076 S 332901 5 4 papnjr4 aie 542217592 pue sriydeus 1x 1 39 1313J31 00 S8E 13A0 01 S5 222 Bp AOId s 23e11sqe u p N SUO JEPUALUWODAaJ JUaWI e 913 p pe18 008 9 19A O 52 d0 00E 8 1 A09 4 S40 1531b 93 J1 2 1no 0 SI AS 42 32 1D p114 0 Sua d 1 1 43M UD2183S 01 10K AQOJ 8 s l1 qede gt 5 j31e s paziwiydD A018 01 s nul1uo2 1 quunu sjy pue seak se s2 d03 ayegoydy uoj DEL 1 A0 pamalA SUB 3IUu 2 L5 98 5092 Paw PEY 239 4183lll143S 331195 s
2. Be of blood pressure Who should be treated Nonpharmacologic therapy Drug treatment General efficacy _ Initial monotherapy in uncomplicated hypertension Combination therap Goal blood pressure Resistant hypertension Discontinuing therapy INFORMATION FOR PATIENTS REFERENCES Print text references graphics or the entire topic Access patient information to share with your patients Submit questions and comments to our editors Calculators _ 3 lt reer er em Overview of hypertension in adults Authors Section Editor Deputy Editor i Frank J Domino MO George L Bakris MD Alice M Sheridan MD Email topics to Norman M Kaplan MO your colleagues or patients Last literature version 18 3 September 2010 This topic last updated June 17 2010 More INTRODUCTION The treatment of tension is the most common reason for office visits of non pregnant adults to physicians in the ted States and for of prescription drugs 1 Analysis of NHANES data from 1999 2000 and United States Census bureau info tion results in ppro ti 29 to 31 percent incidence of hypertension in the 18 r and older population of the Upited States 2 3 This translates into 58 to 65 million hypertensives in the adult population in the United View the date when States which is substantially higher than the 43 2 million estimate derived from the 1988 1991 NHANES III survey 2 4 the topic was last The number of patients
3. 321nosal JO J2 WO 4 13430 01318 qo dq 13J 1d s x8 o3 ino Aym J s130K 10430 D414 s JO s3n b 23 1 2 1134 0 SI3A542 p lJ 0 321nOs 1 131 0 JP 4350 ue 124 a10 u eqol d 01 419 S421113 24 SMOYS JD3193s311J p 31 3P 4i D2 1 S323130531 1012 U10441 P31ul D D 1S111 SOW S D3 IOMA 34 JO 340 S 34e qo d 1ioddas uo s p p se3 321 p A3 p zepd s3Ao9n414093 pase qun ylim 900 00b 13A0 84 1994 MOJ Sued 449 49 AY unu uo 130 120K g ised 34 1 A0 29208 JA M S3111B83J 34 JO Maj e ysn ase a1a 4 A sea pae 323 ND JO JE UJOJ Ply 10K d a 4 91s 001 Ajp4a 14 1957 34 p A013 01 2311 U U02 S 33e go dq 8 11D AO11 1399 sey 342901 d7 sueak g 104 Ayjunwiwos e31ul 2 3599127 SPjJOM 243 01u dey Sainjea4 aA suayaidwoy Use the Find tool to search for a word or synonym within a topic Learn What s Ne by specialty since the last release View a detailed outline within each topic Click on a heading to go directly to the information you ne Review treatment recommendations Provide valuable feedback UpToDate Delivers Powerful Features New Search Patient Info What s New DEFINITIONS Hypertension Malignant Hypertensive ESSENTIAL PRI HYPERTENSION Pathogenesis Risk factors Physical examination Laboratory testing Additional tests _ Testing for renovascular hypertension _ Testing for other causes of identifiable hypertension TREATME
4. JILUVES 115 DL 4 Jado aseayd sS3222 s 4 SMOj e 12 J1 32 M S 2 0 34 19S9 15 UO 3 354 1NOK Dap AOI s3 2l118 D 2 4313431 194 1X31 nJ 91 441 S10 2 INO 0 S 4 U U09 pue s 1011s 1b 1 UgNs 0 NOA smoj e uo ng y gt DeqGQpa a4 s 431 2d 10 sandea jO gt 110A 01 5 do D 13S 0 10K SAOJ e JOO PLu3 s 431 2d 104 Ajjery2ads 439 1UM s2 Jo1 009 3A0 s p1 24 uoleuuloJu 1u lled 3SB 31 Se 84 32uls je 2 ds q s8 1 psy Mau 11e110d u yo Ase u uns e sapiaoid s jJegJ1381B8ue 4 gt 3312214 S3DN I4 4 4M M N S ZLYM Sa gt Aap ayesedas asn 10 sejno 43 4 U3 U9 01 9394 34 84 JEU ul S10 2 79 29 23 Da U 6 9 sS3992 331A01d sio1e n3 e3 40 9219 U 419 4 0 q434 242 J134 0 8 1p 31p 03 8719 sn01 8 sep Ajje 113103 194 yay 0 JP 3 ul 3 MOVE D42 B UP 217 2 4 p Je P 1018 413 4i 311 2 pad 1 15Pe 003 p 1aA0 ID d uo3 x 43 M di ysiauyied 4 aseqezep suol 3e1 lu Snip pue aseqezep 8niq susaysAs p 123 as 4o11e1831u YNI J1 M qel eAe JAD sased 99076 S 332901 5 4 papnjr4 aie 542217592 pue sriydeus 1x 1 39 1313J31 00 S8E 13A0 01 S5 222 Bp AOId s 23e11sqe u p N SUO JEPUALUWODAaJ JUaWI e 913 p pe18 008 9 19A O 52 d0 00E 8 1 A09 4 S40 1531b 93 J1 2 1no 0 SI AS 42 32 1D p114 0 Sua d 1 1 43M UD2183S 01 10K AQOJ 8 s l1 qede gt 5 j31e s paziwiydD A018 01 s nul1uo2 1 quunu sjy pue seak se s2 d03 ayegoydy uoj DEL 1 A0 pamalA SUB 3IUu 2 L5 98 5092 Pa
5. c was last The number of patients with hypertension is likely to grow as the population ages since either isolated systolic hypertension or updated combined systolic gnd diastolic hypertension occurs in over one half of persons older than 65 years figure 1 5 The rising i incidence of obesit will also increase the number of hypertensive individuals 5 See Treatment of hypertension in the elderly cularly isolated systoli pertension Despite the prevaidnce of hypertension and its associated complications control of the disease is from NHANES show that only 34 percent of persons with hypertension have their blood pressure below 140 90 mmHg table 1 7 Slightly higher rates of control were reported in a regional pop and 55 percent of hen and women respectively have controlled hypertension 8 There are numerous potential reasons for low rates of blood pressure control including poor acces to health care and Medications and lack of adherence with long term therapy for a condition that is usually asymptomptic 9 The latter may be particularly true when the therapy may interfere with the patient s quality of life and when its imm diate benefits may not be obvious to the patient Thus hypertension will likely remain the most common risk factor for heart ptt and stroke 10 The definition complications diagnosis evaluation and management of hypertension are reviewedjhere Detailed discussions of all of these issues are found
6. entifiable hypertension TREATME Be of blood pressure Who should be treated Nonpharmacologic therapy Drug treatment General efficacy _ Initial monotherapy in uncomplicated hypertension Combination therap Goal blood pressure Resistant hypertension Discontinuing therapy INFORMATION FOR PATIENTS REFERENCES Print text references graphics or the entire topic Access patient information to share with your patients Submit questions and comments to our editors Calculators _ 3 lt reer er em Overview of hypertension in adults Authors Section Editor Deputy Editor i Frank J Domino MO George L Bakris MD Alice M Sheridan MD Email topics to Norman M Kaplan MO your colleagues or patients Last literature version 18 3 September 2010 This topic last updated June 17 2010 More INTRODUCTION The treatment of tension is the most common reason for office visits of non pregnant adults to physicians in the ted States and for of prescription drugs 1 Analysis of NHANES data from 1999 2000 and United States Census bureau info tion results in ppro ti 29 to 31 percent incidence of hypertension in the 18 r and older population of the Upited States 2 3 This translates into 58 to 65 million hypertensives in the adult population in the United View the date when States which is substantially higher than the 43 2 million estimate derived from the 1988 1991 NHANES III survey 2 4 the topi
7. eviews from adequate 6 8 Data r control defined as a level tion study approximately 45 Link to information about authors and editors DEFINITIONS Access related topics Hypertension Major societies have published definitions of hypertension as will be described below Hypertension was defined to find additional as a blood pressure 2140 290 mmHg However subsequent trials have identifed groups of patients at higher risk in whom goal information blood pressures below this value may be associated with improved outcomes See Goa biood pressure below The following definitions were suggested in 2003 by the seventh report of the Joint National Committee JNC 7 based upon the average of two or more properly measured readings at each of two or more visits after an initial screen 7 Normal blood pressure systolic lt 120 mmHg and diastolic lt 80 mmHg pertension systolic 120 139 mmHg or diastolic 80 89 mmHg Click to view a e Hypertension Stage 1 systolic 14G 159 mmHg or diastolic 90 99 mmHg Stage 2 systolic 21 0 or diastolic 2100 mmHg Isolated systolic hypertengion is considered to be present when the blood pressure is z 140 lt 90 mmHg and isolated diastolic Medline abstract hypertension is conside be present when the blood pressure is lt 140 290 mmHg Helo imorove UoToDate Did UpToDate answer vour auestion gt Yes No
8. separately See appropriate topic reviews from adequate 6 8 Data r control defined as a level tion study approximately 45 Link to information about authors and editors DEFINITIONS Access related topics Hypertension Major societies have published definitions of hypertension as will be described below Hypertension was defined to find additional as a blood pressure 2140 290 mmHg However subsequent trials have identifed groups of patients at higher risk in whom goal information blood pressures below this value may be associated with improved outcomes See Goa biood pressure below The following definitions were suggested in 2003 by the seventh report of the Joint National Committee JNC 7 based upon the average of two or more properly measured readings at each of two or more visits after an initial screen 7 Normal blood pressure systolic lt 120 mmHg and diastolic lt 80 mmHg pertension systolic 120 139 mmHg or diastolic 80 89 mmHg Click to view a e Hypertension Stage 1 systolic 14G 159 mmHg or diastolic 90 99 mmHg Stage 2 systolic 21 0 or diastolic 2100 mmHg Isolated systolic hypertengion is considered to be present when the blood pressure is z 140 lt 90 mmHg and isolated diastolic Medline abstract hypertension is conside be present when the blood pressure is lt 140 290 mmHg Helo imorove UoToDate Did UpToDate answer vour auestion gt Yes No JILUVES 115 DL 4 Jado aseayd
9. w PEY 239 4183lll143S 331195 s321nosal JO J2 WO 4 13430 01318 qo dq 13J 1d s x8 o3 ino Aym J s130K 10430 D414 s JO s3n b 23 1 2 1134 0 SI3A542 p lJ 0 321nOs 1 131 0 JP 4350 ue 124 a10 u eqol d 01 419 S421113 24 SMOYS JD3193s311J p 31 3P 4i D2 1 S323130531 1012 U10441 P31ul D D 1S111 SOW S D3 IOMA 34 JO 340 S 34e qo d 1ioddas uo s p p se3 321 p A3 p zepd s3Ao9n414093 pase qun ylim 900 00b 13A0 84 1994 MOJ Sued 449 49 AY unu uo 130 120K g ised 34 1 A0 29208 JA M S3111B83J 34 JO Maj e ysn ase a1a 4 A sea pae 323 ND JO JE UJOJ Ply 10K d a 4 91s 001 Ajp4a 14 1957 34 p A013 01 2311 U U02 S 33e go dq 8 11D AO11 1399 sey 342901 d7 sueak g 104 Ayjunwiwos e31ul 2 3599127 SPjJOM 243 01u dey Sainjea4 aA suayaidwoy Use the Find tool to search for a word or synonym within a topic Learn What s Ne by specialty since the last release View a detailed outline within each topic Click on a heading to go directly to the information you ne Review treatment recommendations Provide valuable feedback UpToDate Delivers Powerful Features New Search Patient Info What s New DEFINITIONS Hypertension Malignant Hypertensive ESSENTIAL PRI HYPERTENSION Pathogenesis Risk factors Physical examination Laboratory testing Additional tests _ Testing for renovascular hypertension _ Testing for other causes of id
10. with hypertension is likely to grow as the population ages since either isolated systolic hypertension or updated combined systolic gnd diastolic hypertension occurs in over one half of persons older than 65 years figure 1 5 The rising i incidence of obesit will also increase the number of hypertensive individuals 5 See Treatment of hypertension in the elderly cularly isolated systoli pertension Despite the prevaidnce of hypertension and its associated complications control of the disease is from NHANES show that only 34 percent of persons with hypertension have their blood pressure below 140 90 mmHg table 1 7 Slightly higher rates of control were reported in a regional pop and 55 percent of hen and women respectively have controlled hypertension 8 There are numerous potential reasons for low rates of blood pressure control including poor acces to health care and Medications and lack of adherence with long term therapy for a condition that is usually asymptomptic 9 The latter may be particularly true when the therapy may interfere with the patient s quality of life and when its imm diate benefits may not be obvious to the patient Thus hypertension will likely remain the most common risk factor for heart ptt and stroke 10 The definition complications diagnosis evaluation and management of hypertension are reviewedjhere Detailed discussions of all of these issues are found separately See appropriate topic r

User Guide Institutional 18.3

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