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For further information, see CMDT Part 11: Systemic Hypertension

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

Table 11–14.Causes of resistant hypertension.
Table 11–2.Causes of secondary hypertension.


  • Hypertension is uncontrolled in about half of affected people

  • 64% are aware of their condition

  • 60% 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 ...

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