Primary/essential hypertension—95% of all hypertension with no primary etiology identified.
Secondary hypertension—5% secondary to causes including renal disease and endocrine disorders, among others.
Elevated blood pressures should be based on two readings separated by 2 min, with verification of measurement in the contralateral arm.
Close coordination with primary care provider for appropriate evaluation and management of elevated blood pressures. Evaluation may entail obtaining the following information:
Personal and family history of cardiovascular, cerebrovascular, or renal disease, and/or diabetes mellitus.
Diet, sodium intake, drug use (e.g., smoking, alcohol), nutrition, medications (e.g., oral contraceptives).
Comprehensive physical examination, including fundoscopic and neurologic.
Studies including chemistry panel, Ca, Mg, PO4, complete blood cell count (CBC), urinalysis, lipid profile, EKG, chest x-ray.
Hypertension | Systolic Blood | Diastolic Blood | Lifestyle | Pharmacotherapy |
|---|---|---|---|---|
Normal | <120 | And <80 | Encourage | N/A |
Prehypertension | 120-139 | Or 80-89 | Yes | No antihypertensive drug indicated. |
Stage I hypertension | 140-159 | Or 90-99 | Yes | Thiazide-like diuretics and beta-blockers for most. May consider angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or combination. |
Stage II hypertension | ≥160 | Or ≥100 | Yes | 2-drug therapy for most. |
Hypertensive urgency | ≥210 | Or ≥120 and asymptomatic with minimal or no end organ damage | N/A | Reduce blood pressure over 24-48 h using oral agents. |
Hypertensive emergency | ≥180 | Or ≥110 and symptomatic/presence of end organ damage | N/A | Reduce blood pressure with IV antihypertensives and transfer immediately to emergency room. |
Adapted from Chobanian AV, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:25-60. | ||||
Reduce weight to maintain body mass index between 18.5 and 25.
Stop alcohol and cigarette smoking.
Dietary restrictions, including decreasing saturated fat, low cholesterol diet, reducing sodium intake to 2.4 g per day (6 g of sodium).
Increase aerobic physical activity (30-45 min most days of the week).
Strict glucose control in diabetes mellitus.
Regular follow-up with primary care provider.Related posts:
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