Hypertension Disease Summary

Overview

Hypertension is the medical term for high blood pressure as stated in the Introduction section. This may be due to multiple factors which are discussed in the Pathophysiology section.

An estimated 1.28 billion adults aged 30-79 years old have hypertension according to the World Health Organization (WHO) and two-thirds of these are living in low- and middle-income countries. The incidence of hypertension locally and regionally is featured in the Epidemiology section.

Various consensus guidelines are available as standard references for the definition of hypertension.  The differences in the classification of blood pressure are shown in the Classification section.  The stages of hypertension are also in this section.

Hypertension_Disease Summary

History and Physical Examination

A good history and physical examination should be taken during the primary visit of the patient. Signs and symptoms and factors to look for in these examinations are enumerated and discussed in the History and Physical Examination sections.

Proper blood pressure measurements in and out of the clinic are essential in screening patients suspected of having hypertension. These are discussed in the Screening section as well as the blood pressure levels defining hypertension in different settings. Discussion on screening for secondary causes of hypertension or evidence of target organ damage is also in this section.  

Diagnosis

Laboratory Tests and Ancillaries and Imaging studies to be considered in the work-up of patients with hypertension are discussed in these sections.

Causes of secondary hypertension should be ruled out, especially in patients at extremes of age, and these are enumerated in the Differential Diagnosis section.

Management

Patients with hypertension should be assessed further to identify secondary causes, target organ damage, cardiovascular disease risk factors or other disorders that may affect prognosis.  This is discussed in the Evaluation section. Risk stratification for guidance on the management of hypertension and subsequent follow-up is also featured in this section.

Treatment goals, target blood pressure, treatment initiation and regimen, and choice of antihypertensive agents are discussed in detail in the Principles of Therapy section.

The WHO recommends the use of medications from any of the following three drug classes as first-line antihypertensive agents: Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), calcium antagonists, and thiazide and thiazide-like diuretics. These are discussed in detail in the Pharmacological Therapy section. Other antihypertensive agents, antihypertensive combinations and management of resistant hypertension discussions are also in this section.

Several non-drug options to consider that may aid in the management of hypertension such as patient education (eg blood pressure measurement and monitoring) and lifestyle modification (eg weight reduction and maintenance, dietary changes, regular exercise, limiting alcohol consumption, smoking cessation) are featured in the Nonpharmacological section.  

It is recommended to have regular assessment of blood pressure control to determine the effectiveness of the management given and to identify any hypertension-mediated organ damage. This is discussed in the Monitoring section.