<unk>  is diagnosed on the basis of a persistently high resting blood pressure. The American Heart Association recommends at least three resting measurements on at least two separate health care visits. The UK National Institute for Health and Care Excellence recommends ambulatory blood pressure monitoring to confirm the diagnosis of<unk>  if a clinic blood pressure is 140/90 mmHg or higher. Measurement technique For an accurate diagnosis of<unk>  to be made, it is essential for proper blood pressure measurement technique to be used. Improper measurement of blood pressure is common and can change the blood pressure reading by up to 10 mmHg, which can lead to misdiagnosis and misclassification of<unk> . Correct blood pressure measurement technique involves several steps. Proper blood pressure measurement requires the person whose blood pressure is being measured to sit quietly for at least five minutes which is then followed by application of a properly fitted blood pressure cuff to a bare upper arm. The person should be seated with their back supported, feet flat on the floor, and with their legs uncrossed. The person whose blood pressure is being measured should avoid talking or moving during this process. The arm being measured should be supported on a flat surface at the level of the heart. Blood pressure measurement should be done in a quiet room so the medical professional checking the blood pressure can hear the Korotkoff sounds while listening to the brachial artery with a stethoscope for accurate blood pressure measurements. The blood pressure cuff should be deflated slowly (2-3 mmHg per second) while listening for the Korotkoff sounds. The bladder should be emptied before a person's blood pressure is measured since this can increase blood pressure by up to 15/10 mmHg. Multiple blood pressure readings (at least two) spaced 1–2 minutes apart should be obtained to ensure accuracy. Ambulatory blood pressure monitoring over 12 to 24 hours is the most accurate method to confirm the diagnosis. An exception to this is those with very high blood pressure readings especially when there is poor organ function. With the availability of 24-hour ambulatory blood pressure monitors and home blood pressure machines, the importance of not wrongly diagnosing those who have white coat<unk>  has led to a change in protocols. In the United Kingdom, current best practice is to follow up a single raised clinic reading with ambulatory measurement, or less ideally with home blood pressure monitoring over the course of 7 days. The United States Preventive Services Task Force also recommends getting measurements outside of the healthcare environment. Pseudohypertension in the elderly or noncompressibility artery syndrome may also require consideration. This condition is believed to be due to calcification of the arteries resulting in abnormally high blood pressure readings with a blood pressure cuff while intra arterial measurements of blood pressure are normal. Orthostatic<unk>  is when blood pressure increases upon standing. Other investigations + Typical tests performed System Tests Kidney Microscopic urinalysis, protein in the urine, BUN, creatinine Endocrine Serum sodium, potassium, calcium, TSH Metabolic Fasting blood glucose, HDL, LDL, total cholesterol, triglycerides Other Hematocrit, electrocardiogram, chest radiograph Once the diagnosis of<unk>  has been made, healthcare providers should attempt to identify the underlying cause based on risk factors and other symptoms, if present. Secondary<unk>  is more common in preadolescent children, with most cases caused by kidney disease. Primary or essential<unk>  is more common in adolescents and adults and has multiple risk factors, including obesity and a family history of<unk> . Laboratory tests can also be performed to identify possible causes of secondary<unk> , and to determine whether<unk>  has caused damage to the heart, eyes, and kidneys. Additional tests for diabetes and high cholesterol levels are usually performed because these conditions are additional risk factors for the development of heart disease and may require treatment. Initial assessment of the hypertensive people should include a complete history and physical examination. Serum creatinine is measured to assess for the presence of kidney disease, which can be either the cause or the result of<unk> . Serum creatinine alone may overestimate glomerular filtration rate and recent guidelines advocate the use of predictive equations such as the Modification of Diet in Renal Disease (MDRD) formula to estimate glomerular filtration rate (eGFR). eGFR can also provide a baseline measurement of kidney function that can be used to monitor for side effects of certain anti-hypertensive drugs on kidney function. Additionally, testing of urine samples for protein is used as a secondary indicator of kidney disease. Electrocardiogram (EKG/ECG) testing is done to check for evidence that the heart is under strain from high blood pressure. It may also show whether there is thickening of the heart muscle (left ventricular hypertrophy) or whether the heart has experienced a prior minor disturbance such as a silent heart attack. A chest X-ray or an echocardiogram may also be performed to look for signs of heart enlargement or damage to the heart. Classification in adults +Classification in adults (Persons with systolic and diastolic in different categories are assigned to the higher category.) Category Systolic, mmHg Diastolic, mmHg Hypotension 90–129 60–7960–84 Prehypertension(high normal, elevated) 120–129130–139 60–7985–89 Stage 1<unk>  130-139140–159 80-89 90–99 Stage 2<unk>  >140160–179 >90100–109 Hypertensive crises ≥ 180 ≥ 120 Isolated systolic<unk>  ≥ 140 < 90 Isolated diastolic<unk>  < 140 ≥ 90 In people aged 18 years or older<unk>  is defined as either a systolic or a diastolic blood pressure measurement consistently higher than an accepted normal value (this is above 129 or 139 mmHg systolic, 89 mmHg diastolic depending on the guideline). Other thresholds are used (135 mmHg systolic or 85 mmHg diastolic) if measurements are derived from 24-hour ambulatory or home monitoring. Recent international<unk>  guidelines have also created categories below the hypertensive range to indicate a continuum of risk with higher blood pressures in the normal range. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) published in 2003 uses the term prehypertension for blood pressure in the range 120–139 mmHg systolic or 80–89 mmHg diastolic, while European Society of<unk>  Guidelines (2007) and British<unk>  Society (BHS) IV (2004) use optimal, normal and high normal categories to subdivide pressures below 140 mmHg systolic and 90 mmHg diastolic.<unk>  is also sub-classified: JNC7 distinguishes<unk>  stage I,<unk>  stage II, and isolated systolic<unk> . Isolated systolic<unk>  refers to elevated systolic pressure with normal diastolic pressure and is common in the elderly. The ESH-ESC Guidelines (2007) and BHS IV (2004) additionally define a third stage (stage III<unk>  for people with systolic blood pressure exceeding 179 mmHg or a diastolic pressure over 109 mmHg.<unk>  is classified as "resistant" if medications do not reduce blood pressure to normal levels. In November 2017, the American Heart Association and American College of Cardiology published a joint guideline which updates the recommendations of the JNC7 report. The 2020 International Society of<unk>  guidelines define<unk>  based on office blood pressure ≥140/90 mmHg or home monitoring blood pressure ≥135/85 mmHg, or 24-hour ambulatory blood pressure average ≥130/80 mmHg (daytime average ≥135/85 mmHg or nighttime average BP ≥120/70 mmHg). Children<unk>  occurs in around 0.2 to 3% of newborns; however, blood pressure is not measured routinely in healthy newborns.<unk>  is more common in high risk newborns. A variety of factors, such as gestational age, postconceptional age and birth weight needs to be taken into account when deciding if a blood pressure is normal in a newborn.<unk>  defined as elevated blood pressure over several visits affects 1% to 5% of children and adolescents and is associated with long term risks of ill-health. Blood pressure rises with age in childhood and, in children,<unk>  is defined as an average systolic or diastolic blood pressure on three or more occasions equal or higher than the 95th percentile appropriate for the sex, age and height of the child. High blood pressure must be confirmed on repeated visits however before characterizing a child as having<unk> . Prehypertension in children has been defined as average systolic or diastolic blood pressure that is greater than or equal to the 90th percentile, but less than the 95th percentile. In adolescents, it has been proposed that<unk>  and pre-hypertension are diagnosed and classified using the same criteria as in adults. The value of routine screening for<unk>  in children over the age of 3 years is debated. In 2004 the National High Blood Pressure Education Program recommended that children aged 3 years and older have blood pressure measurement at least once at every health care visit and the National Heart, Lung, and Blood Institute and American Academy of Pediatrics made a similar recommendation. However, the American Academy of Family Physicians supports the view of the U.S. Preventive Services Task Force that the available evidence is insufficient to determine the balance of benefits and harms of screening for<unk>  in children and adolescents who do not have symptoms.
Hypertension
Obesity
Prehypertension
Diabetes
Body mass index
Abdominal obesity
Smoking
Exercise