AHA High Blood Pressure Toolkit

8 Hypertension Guideline Toolkit for Healthcare Providers DIAGNOSING Screening for White-Coat and Masked Hypertension The prevalence of white-coat or masked hypertension has been approximately 10% in population-based surveys and in as many as 33% of patient registries. These conditions can have a substantial impact, with white-coat hypertension leading to overtreatment and masked hypertension to undertreatment. An important component of accurately diagnosing elevated BP or hypertension is screening for these two phenomenon. The guideline states it is reasonable to screen for white-coat hypertension in adults with: • untreated systolic BP >130 mm Hg, < 160 mm Hg • diastolic BP: > 80 mm Hg, < 100 mm Hg It is reasonable to screen for masked hypertension for adults with untreated office-measured BPs that are consistently 120-129 mm Hg (systolic) or 75-79 mm Hg (diastolic) Screening for Secondary Hypertension Determining whether hypertension has a secondary cause is also a component of the appropriate diagnosis of elevated BP or hypertension. Secondary causes of hypertension are responsible for high BP in approximately 10% of patients with hypertension. The following are the most common causes of secondary hypertension with prevalence indicated in parentheses. • Obstructive sleep apnea (25-50%) • Renovascular disease (5-34%) • Primary aldosteronism (8-20%) • Drugs or alcohol such as sodium containing antacids, caffeine, nicotine, NSAIDS, oral contraceptives and others (2-4%) • Renal parenchymal disease (1-2%) Note: Some uncommon, but important causes of secondary hypertension include pheochromocytoma/paraganglioma, Cushing’s syndrome, hypo- or hyperthyroidism, aortic coarctation and others. In Practice See more information on secondary hypertension, clinical implications, prevalence, physical examination and screening tests. Algorithm for Screening for Secondary Hypertension Algorithms for Detecting White-Coat or Masked Hypertension • Patients Not Receiving Drug Therapy • Patients Receiving Drug Therapy Emphasize the importance of monitoring BP at home a nd encourage patients to use online resources to help ensure accurate measurements and tracking. Self-Monitoring of BP Patient self-monitoring of BP is an important focus of the 2017 guideline. Patient training should be done under medical supervision, with focus on evaluating the device used in the home and providing detailed instructions for proper measurement .