Evaluation of Patients with Hypertension: Diagnosis, Screening and Risk Stratification

Hypertension has been defined as blood pressure levels of 140/90mm Hg or greater. This has been arbitrarily based on epidemiological evidence that demonstrates the risk associated with blood pressure levels and the benefits to be expected from therapy. Conventional blood pressure measurements with a sphygmomanometer are adequate in most patients for evaluation of arterial hypertension. Out-of-office self-measurements of blood pressure or 24-hour blood pressure recordings provide useful additional information and can help to exclude `white coat hypertension' or office hypertension. The objective of screening patients with hypertension is to detect any treatable causes and to assess the cardiovascular risk by ascertaining the extent of target organ damage and other cardiovascular risk factors. A basic screening programme is appropriate in the majority of older patients with hypertension to exclude treatable causes. Additional investigations are necessary in young patients and those with suspicion of an identifiable cause. Target organ damage and cardiovascular risk factors have to be evaluated in each patient with hypertension since the incidence of cardiovascular disease is related to the profile of these risk factors. Accordingly, the clinical management of patients with hypertension depends not on blood pressure levels alone but also on the burden of associated risk factors. The Sixth Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure has recently recommended a classification that stratifies patients with hypertension into risk groups for therapeutic decisions. It has to be pointed out that there is uncertainty about the prognostic relevance of risk stratification in patients over the age of 80 years.