Relative tachycardia in ambulant children with borderline hypertension

Initial assessment of the patient with hypertension

The initial assessment of a patient with hypertension can easily be done in a primary-care setting. The goals of the examination are to determine whether the patient is truly hypertensive and, if so, the severity of the hypertension, the degree of target-organ involvement, the presence of curable causes of hypertension, the patient's overall cardiovascular risk profile, and the patient's understanding and willingness to adopt necessary life-style changes and comply with treatment.

Blood pressure at rest and during maximal dynamic and isometric exercise as predictors of systemic hypertension

This study sought to verify evidence that transient high blood pressure (BP) at rest and during dynamic and isometric exercise is often predictive of later hypertension. In addition these 3 predictors were compared. One hundred office patients (all men) with BPs less than 140/90 mm Hg, ages 28 to 79 years, who had little or no heart disease and were not taking medication, had BPs taken at rest and during treadmill and handgrip dynamometer. Within 14 years, 16 subjects developed hypertension and 84 remained normotensive. Multivariate statistical comparisons for systolic and diastolic BPs and their interactions were used to discriminate between later hypertensive and normotensive subjects. The best single predictor was resting diastolic BP, classifying 88% of hypertensive and 69% of normotensive subjects correctly, followed closely by handgrip and treadmill diastolic BP and resting, treadmill and handgrip systolic BP. The best prediction was by the interaction between resting diastolic BP X handgrip diastolic BP; this classified 88% of hypertensive and 80% of normotensive subjects correctly. Of the few known precursors of hypertension, high BP at rest and during dynamic and isometric stress provides a means of alerting to careful follow-up and early treatment.