Hypertension, Essential

Descriptive text is not available for this image Basics

Description

  • Primary hypertension (HTN) is HTN without an identifiable cause; also known as essential HTN; an important risk factor for cardiovascular disease (CVD), and other comorbidities much controversy regarding recommended thresholds for diagnosis and treatment remains
  • HTN is defined (Joint National Committee [JNC] 8 and the International Society of Hypertension) as (all pressures in mm Hg) (1):
    • Age <60 years: systolic BP (SBP) ≥140 and/or diastolic BP (DBP) ≥90 at ≥2 visits
    • Age ≥60 years: SBP ≥150 and/or DBP ≥90 at ≥2 visits
    • With diabetes or chronic kidney disease (CKD): SBP ≥140 and/or DBP ≥90
  • The American College of Cardiology (ACC)/American Heart Association (AHA) designates SBP ≥130 and/or DBP ≥80 as “stage 1 hypertension” which should be treated with exercise and lifestyle modification, reserving medication for patients at “higher risk” (defined as age ≥65, CKD, diabetes, or known CVD).

Geriatric Considerations

Isolated systolic HTN is common. Therapy is effective at preventing stroke, CVD, and all-cause mortality (2)[A]. Optimal targets for blood pressure can remain the same, but adverse reactions to medications are more frequent, which may change treatments targets. ACC/AHA does not make specific recommendations regarding choice of antihypertensive in older adults. Individualize target and treatment based on patient risks, preferences, and medication tolerance.

Pediatric Considerations
HTN in children is defined as SBP or DBP ≥95th percentile on repeated measurements. Measure BP during routine exams beginning at age 3 years; pre-HTN: SBP or DBP between 90th and 95th percentilePregnancy Considerations
Elevated BP during pregnancy may represent chronic HTN, pregnancy-induced HTN, or preeclampsia. Preferred agents: labetalol, nifedipine, methyldopa, or hydralazine (see “Preeclampsia and Eclampsia [Toxemia of Pregnancy]”).

Epidemiology

Prevalence

Almost half of adults (48.1%) in the United States have HTN by ACC/AHA guideline; prevalence is higher in men.

Etiology and Pathophysiology

>90% of cases of HTN have no identified cause. For differential diagnoses and causes of secondary HTN, see “Hypertension, Secondary and Resistant.”

Risk Factors

Family history, obesity, alcohol use, excess dietary sodium, stress, physical inactivity, tobacco use, insulin resistance, obstructive sleep apnea (OSA), and other causes of sleep disruption

There's more to see -- the rest of this topic is available only to subscribers.