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hypertension
HYPERTENSION
Treatment Guideline Chart
Hypertension is the medical term for high blood pressure. Persistent high blood pressure can lead to increased strain to the heart and arteries that can eventually cause organ damage.
To classify the blood pressure, it must be based on ≥2 properly measured, seated blood pressure readings on each of ≥2 office visits.
Goals of therapy are to manage hypertension that can maintain the patient's normal blood pressure and identify and treat all reversible risk factors.

Hypertension Signs and Symptoms

Introduction


  • Hypertension is the medical term for high blood pressure (BP)
  • Symptoms may come from secondary causes, concomitant diseases, or from target organ damage (TOD)
  • Assessment with lab tests and imaging may be done to exclude secondary causes, additional cardiovascular risk factors, or TOD

Epidemiology

  • The World Health Organization (WHO) estimated hypertension to occur in 1.28 billion adults aged 30-79 years old and ⅔ of these are living in low- and middle-income countries
  • Global prevalence of hypertension using the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of hypertension was estimated in 2019 at 1.3 billion
  • About 46% of adults with hypertension are not aware that they have hypertension
  • About 42% of adults with hypertension are diagnosed and managed

Pathophysiology

  • Due to multiple factors including neural and chemical disorders, alterations of vascular caliber and elasticity, cardiovascular (CV) reactivity, blood volume and viscosity
    • BP maintenance is complex and involves several physiological mechanisms including arterial baroreceptors, the renin-angiotensin-aldosterone system, atrial natriuretic peptide, endothelins, and mineralocorticoid and glucocorticoid steroids, which together manage the degree of vasoconstriction or vasodilation within the systemic circulation, and the retention of water and sodium to maintain adequate circulating blood volume and a dysfunction in any of these processes can lead to hypertension development
    • Sympathetic neural activation modulates hypertension by enhancing vasoconstriction and vascular remodeling, producing renal renin via beta 1 adrenergic receptors in the juxtaglomerular apparatus and increasing renal sodium resorption and inflammation
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