Hypertension Diagnosis: Key Considerations and Guidelines

Diagnosis of Hypertension

Dear Director,
I have never had any hypertension-related inquiries or medical records.
For health management, I have been visiting a traditional Chinese medicine clinic for a long time.
On June 13, 2019, I participated in the annual employee health check organized by my company at Tai An Hospital.
About a month later, I received the health check report.
When I returned to the traditional Chinese medicine clinic on July 13, I brought the health check report for reference.
The report indicated a blood pressure reading of 90 mmHg diastolic.
Although there was a blood pressure monitor available in the clinic, the physician did not remeasure my blood pressure for confirmation and directly diagnosed me with hypertension based on the data from Tai An Hospital's health check report.
Upon reviewing relevant information:
1.
According to the Ministry of Health and Welfare's National Health Administration website column by Dr.
Ma Rui-shan titled "Health Self-Management - Correct Blood Pressure Measurement" (published on May 21, 2018): A single measurement indicating hypertension does not equate to true hypertension...
If three measurements exceed normal values, only then can hypertension be diagnosed.
Note: I only had my blood pressure measured once during the health check.
2.
The 2016 Hypertension Treatment Guidelines by the Taiwan Society of Cardiology and the Hypertension Society state: (1) The consensus from the World Health Organization, American and European Cardiology Societies, and the National Joint Committee on Hypertension is that treatment is required when blood pressure exceeds 140/90 mmHg (p.
8).
(2) For individuals under 80 years old without comorbidities such as coronary artery disease, diabetes, or chronic kidney disease with proteinuria, the blood pressure control standard is below 140/90 mmHg (p.
9).
(3) After three months of dietary and lifestyle adjustments, if blood pressure remains above the standard, medication treatment is recommended (p.
13).
Furthermore, the health check report provided by Tai An Hospital does not confirm that I have hypertension.
The report states: (1) Physician's recommendation: Maintain a light diet due to abnormal diastolic pressure...
(2) Reminder: Screening has definite positive value but is not a diagnosis...
Blood pressure is a fluctuating value; diagnosing hypertension based solely on one health check report without remeasuring my blood pressure seems inappropriate.

In the case of an unclear hypertension diagnosis, would long-term use of antihypertensive medication affect normal blood pressure or lead to other adverse effects? I kindly request your assistance with these concerns.
Thank you.

ttvfish, 50~59 year old female. Ask Date: 2019/12/26

Dr. He Dongjin reply Cardiology

Hello, you are correct that a single health check report showing a blood pressure value above the reference range should not be used to diagnose hypertension.
Medication can be deferred initially; however, in cases of undetermined hypertension, long-term use of antihypertensive medication is unlikely to adversely affect normal blood pressure or cause other negative effects, so there is no need for concern.
Additionally, blood pressure is often unstable during health check-ups, and it should not be the sole basis for diagnosis.
Changhua Hospital cares about your well-being.

Reply Date: 2019/12/26

More Info

Understanding hypertension diagnosis is crucial for effective management and treatment. Hypertension, or high blood pressure, is often referred to as a "silent killer" because it typically has no symptoms until significant damage has occurred. The diagnosis of hypertension is not straightforward and requires careful consideration of various factors.

Key Considerations in Hypertension Diagnosis
1. Multiple Readings: As you mentioned, a single measurement of elevated blood pressure does not confirm a diagnosis of hypertension. According to guidelines from organizations such as the American Heart Association and the European Society of Hypertension, a diagnosis of hypertension typically requires at least two or more readings taken on different occasions. This is because blood pressure can fluctuate due to various factors, including stress, physical activity, and even the time of day.

2. Blood Pressure Categories: Blood pressure is categorized into different ranges:
- Normal: Less than 120/80 mmHg
- Elevated: Systolic between 120-129 and diastolic less than 80
- Hypertension Stage 1: Systolic between 130-139 or diastolic between 80-89
- Hypertension Stage 2: Systolic 140 or higher or diastolic 90 or higher
- Hypertensive Crisis: Systolic over 180 and/or diastolic over 120
Your reported diastolic pressure of 90 mmHg falls into the category of Stage 1 hypertension, but again, this should be confirmed with multiple readings.

3. Contextual Factors: The context in which blood pressure is measured is also important. Factors such as anxiety during a medical visit (often referred to as "white coat syndrome"), recent physical activity, or even caffeine intake can temporarily elevate blood pressure readings. Therefore, it is essential for healthcare providers to consider these factors when interpreting blood pressure measurements.

4. Follow-Up and Monitoring: If a diagnosis of hypertension is made, it is crucial to monitor blood pressure regularly. Lifestyle modifications, such as dietary changes, increased physical activity, and weight management, should be the first line of intervention. If blood pressure remains elevated despite these changes, medication may be necessary.

Guidelines for Treatment
1. Lifestyle Modifications: The first step in managing hypertension typically involves lifestyle changes. This includes adopting a heart-healthy diet (like the DASH diet), reducing sodium intake, engaging in regular physical activity, maintaining a healthy weight, limiting alcohol consumption, and avoiding tobacco use.

2. Medication: If lifestyle changes are insufficient to control blood pressure, antihypertensive medications may be prescribed. The choice of medication depends on various factors, including the patient's overall health, the presence of other medical conditions, and potential side effects. Long-term use of antihypertensive medications is generally safe, but it requires regular monitoring to ensure that blood pressure remains within target ranges.

3. Regular Check-Ups: Regular follow-up appointments are essential to monitor blood pressure and assess the effectiveness of treatment. Adjustments to medication or lifestyle recommendations may be necessary based on these evaluations.

Concerns About Long-Term Medication Use
Regarding your concern about the long-term use of antihypertensive medications potentially affecting normal blood pressure or causing adverse effects, it is important to understand that these medications are designed to help maintain blood pressure within a healthy range. While some individuals may experience side effects, many people tolerate these medications well. Regular follow-up with your healthcare provider can help manage any side effects and ensure that the treatment plan remains appropriate.

Conclusion
In summary, diagnosing hypertension requires careful assessment, including multiple blood pressure readings and consideration of contextual factors. If hypertension is diagnosed, lifestyle modifications are the first step, followed by medication if necessary. Regular monitoring and follow-up with a healthcare provider are essential to effectively manage blood pressure and minimize the risk of complications. If you have concerns about your diagnosis or treatment plan, seeking a second opinion or discussing your concerns with your healthcare provider is always a good idea.

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