Definition:
Hypertension, or elevated blood pressure, is defined as a blood pressure >140/>90mmHg. It is one of the most common worldwide diseases and has an extensive list of morbidities. The JNC-VII classification can be used to stage hypertension as a function of the blood pressure ranges. There are two types of hypertension, primary/essential (no known cause, 90-95% of cases) and secondary (known case, 5-10% of cases). There are numerous causes of secondary hypertension, including renal disease (kidney disease), renovascular hypertension (kidney vessels), vascular (blood vessels), endocrine disease (include OCPs, thyroid, parathyroid), adrenal disease, metabolic problems, genetic diseases, neurological diseases, pregnancy, and drugs/toxins.
Symptoms:
- Patients usually have no symptoms unless there is secondary hypertension, and then it relates to the cause itself.
Diagnosis:
- Must be confirmed elevated blood pressure of >140/>90mmHg on 3 separate occasions, evaluate for extent of target organ damage, cardiovascular risk status, and exclude secondary hypertension causes
- Routine labs (unless secondary hypertension) include chemistry panel, CBC, lipid/fat profile
- EKG to evaluate heart rhythm and size
Treatment:
- Based off JNC-VII Classification and Management of Hypertension
- Normal (<120/<80) - none
- Prehypertension (120-139/80-89) - life-style modification
- Sodium-restricted diets (<2g/day)
- Weight reduction/exercise
- Limit alcohol intake
- Stage I Hypertension (140-159/90-99) - start medications
- Thiazide diuretic is 1st line - reduces fluid volume
- Also consider the following:
- ACE inhibitor - reduces resistance in vessels and water/salt retention in body
- ARBs - similar to ACE inhibitor, but with fewer side effects
- Beta-blocker - reduce renin release and decrease heart output
- Calcium-channel blocker - reduce smooth muscle tone
- Stage II Hypertension (>160/>100) - two-drug combination
- Thiazide diuretic ACE-I/ARB/Beta-blocker/CCB
Consequences:
