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KEY POINTS

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  • Blood pressure goals should be individualized, especially for older people who may have difficulty tolerating complicated pharmacotherapy regimens.

  • The MTM provider should review the medication profile to screen for other medications (eg, NSAIDs) that may be contributing to high blood pressure.

  • Because blood pressure medications may make patients feel worse than hypertension itself, nonadherence is a common problem. MTM providers should be vigilant for nonadherence to medications and, if needed, recommend changes in pharmacotherapy to promote adherence.

  • Regular follow-up and monitoring are key to helping patients achieve blood pressure goals and reduce the risk of end-organ damage.

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INTRODUCTION TO HYPERTENSION

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Primary (essential) hypertension is persistently elevated arterial blood pressure (BP) in the absence of an identifiable cause.1, 2 The relationship between high blood pressure and risk of cardiovascular disease is significant and independent of other risk factors.

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Blood pressure should be classified on the basis of at least 2 readings taken on at least 2 separate occasions (Table 27-1). When systolic and diastolic blood pressure levels fall into different categories, the higher category should be selected.

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Table Graphic Jump Location
Table 27-1.Classification of Blood Pressure in Adults (Age ≥ 18 Years)a
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Other Terms Associated with Hypertension

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  • Hypertensive crises

    • Hypertensive emergency—BP is higher than 180/120 mm Hg and there is ongoing or progressive target organ damage

    • Hypertensive urgency—systolic blood pressure (SBP) is higher than 180 mm Hg or diastolic blood pressure (DBP) is higher than 110 mm Hg and there is no evidence of progressive target organ damage

  • Isolated systolic hypertension—SBP is higher than 140 mm Hg and DBP is lower than 90 mm Hg; common in elderly people

  • Masked hypertension—BP taken at home is significantly higher than anticipated based on the in-clinic BP measurement (opposite of white coat hypertension)

  • Orthostatic hypotension...

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