Hypertension, Chronic

Key Features

Essentials of Diagnosis

• For conventional office-based blood pressure (BP) measurement, the American College of Cardiology and American Heart Association (ACC/AHA) suggest that

  • Normal BP be defined as < 120/80 mm Hg

  • Elevated BP, as 120–129/< 80 mm Hg

  • Stage 1 hypertension, as 130–139/80–89 mm Hg

  • Stage 2 hypertension, as ≥ 140/ ≥ 90 mm Hg

• Usually asymptomatic

• Severe hypertension: occipital headache at awakening, blurry vision

General Considerations

• Mild to moderate hypertension nearly always asymptomatic

• Severe hypertension usually due to

  • Parenchymal renal disease

  • Endocrine abnormalities

  • Renal artery stenosis

  • Drug use

  • Abrupt cessation of antihypertensive medications

• Resistant hypertension is defined as failure to reach blood pressure (BP) control in patients adherent to full doses of a three-drug regimen (including a diuretic)

• Table 11–14 summarizes reasons for failure to reach BP control

Demographics

• About 45% of adults in the United States have a BP > 140/90 mm Hg or are receiving antihypertensive treatment

• 80% are aware of their condition

• 52% of those treated have BP under control

• Incidence of hypertension increases with age

• More men than women in early life

• More women than men later in life

• More common in black Americans (up to 25%)

Clinical Findings

Symptoms and Signs

• Usually asymptomatic

• Headaches are most frequent symptom but are nonspecific

• Elevated BP

• Loud A2 on cardiac examination

• Retinal arteriolar narrowing with "silver-wiring," arteriovenous nicking

• Flame-shaped hemorrhages

• Laboratory findings usually ...