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Hypertension

Hypertension defined as systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg.

Hypertension is diagnosed after two or more consecutive elevated blood pressure readings at two or more office visits after an initial screening.

Systolic Diastolic
Normal < 120 mmHg and < 80 mmHg
Prehypertension 120-139 mmHg or 80-89 mmHg
Stage I Hypertension 140-159 mmHg or 90-99 mmHg
Stage II Hypertension greater than or equal to 160 mmHg greater than or equal to 100 mmHg

*Essential (primary or idiopathic HTN) comprises of 85-95% of all HTN cases

​-Although the mechanism is unclear, Factors such as dietary sodium, obesity, stress, and sedentary lifestyle are responsible for hypertension in genetically predisposed individual. Patients >65, high sodium intake is more likely to precipitate hypertension.

*Secondary hypertension

-Causes include primary aldosteronism, renal parenchymal disease such as glomerulonephritis, polycystic renal disease, Cushing syndrome, congenital adrenal hyperplasia, hyperthyroidism and coarctation of aorta. Use of sympathomimetics, excessive alcohol, corticosteroids, or cocaine worsen blood pressure control.

*Hypertensive urgency

-defined as systolic blood pressure > 180 or diastolic blood pressure > 120 without signs of end organ damage

-blood pressure should be slowly lowered over a period of minutes to hours with an antihypertensive agent. The initial goal in hypertensive emergencies is to reduce the blood pressure by no more than 25% within minutes to 2 hours, and then toward a level of 160/100 mmHg within a total of 2 to 6 hours. Excessive reduction in blood pressure can precipitate coronary, cerebral, or renal ischemia and possibly infarction.​

*Hypertensive emergency

-defined as systolic blood pressure >  180 or diastolic blood pressure > 110 with signs of end organ damage.

-blood pressure can be gradually lowered over 24 to 48 hours. The initial goal in hypertensive urgency is to reduce the blood pressure by no more than 25% within the first 24 hours and toward a level of 160/100 mmHg

*Signs and symptoms

– HTN is usually asymptomatic until complications develop in target organs. Uncomplicated hypertension usually causes dizziness, flushed facies, fatigue, headache, or epistaxis. Severe, untreated hypertension can cause cardiovascular, neurological, renal and retinal symptoms. It is important to treat hypertension early, before it causes damage to the organs

 

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