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POINT-OF-CARE GUIDES
Initial Evaluation of Hypertension
Mark H. Ebell, M.D., M.S., Athens, Georgia
Am Fam Physician. 2004 Mar 15;69(6):1485-1487.
Evidence Summary
The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
recently released its seventh report (JNC 7).1 This guideline takes a largely evidence-based approach to the
development of recommendations. Key changes from the previous guideline (JNC VI, 1997) include the
addition of a “prehypertension” category, revised recommendations for patients with important
comorbidities, and the recognition that most patients need at least two drugs to control their hypertension.
A directed laboratory evaluation completes the survey for target-organ damage and the initial evaluation for
secondary hypertension. It should be noted that the JNC 7 report recommends pursuing more invasive
testing only in the following circumstances: if the initial evaluation raises suspicion for secondary causes; if
the patient’s hypertension is difficult to control; if blood pressure responds poorly to drug therapy; or if onset
of hypertension is sudden.
Another section of the encounter form provides target blood pressures, lists recommendations for lifestyle
changes, and provides a place for the physician to record the initial choice of drug therapy (if any) and a
recommendation for follow-up.
A list of secondary causes of hypertension and suggested tests for initial evaluation of these conditions
A guide for initial drug selection based on comorbidities
Usual dosages of commonly used generic drugs
A table for quickly determining body mass index
Use of this encounter form should make it easier for family physicians to provide care that is consistent with
the JNC 7 guidelines, resulting in improved outcomes for their patients.
REFERENCES
1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh Report of the Joint
National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension.
2003;42:1206–52.
2. Green L. JNC 7 Express: new thinking in hypertension treatment [Editorial]. Am Fam Physician.
2003;68:228,230.
3. Ressel GW, NHLBI. . NHLBI releases new high blood pressure guidelines. [Prac Guide]. Am Fam Physician.
2003;68:376,379
This guide is one in a series that offers evidence-based tools to assist family physicians in improving their decision-
making at the point of care. The series is published in partnership with Family Practice Management. A related article,
which also includes the hypertension encounter form, appears in the March issue of FPM, pages 79–81.
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