Overview
Hypertension is the medical term for high blood pressure (BP) 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 BP are shown in the Classification section. The stages of hypertension are also in this
section.
Hypertension_Disease SummaryHistory 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 BP 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 BP 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 (CVD) 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 BP, 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 BP 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 BP control to determine the effectiveness of the management given and to
identify any hypertension-mediated organ damage. This is discussed in the Monitoring section.
