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FOUNDATION OVERVIEW

Hypertension is defined as persistently elevated arterial blood pressure (BP). BP is the mathematical product of peripheral vascular resistance (PVR) and cardiac output (CO) and hypertension is the result of increased PVR or CO. Aberrations in the normal function of neurohormonal systems, such as the renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system (SNS), and disturbances in sodium, calcium, and natriuretic hormones, have been implicated in the pathophysiology of hypertension (Table 3-1). Hypertension is usually multifactorial; consequently, multiple antihypertensive drugs are often necessary to control BP. Cardiovascular risk reduction can occur with lower BP. A reduction in systolic blood pressure (SBP) as small as 2 mm Hg reduces the risk of death from ischemic heart disease or other vascular causes by 7% and from stroke by 10%. The majority of patients with hypertension have essential hypertension because their BP is elevated for unknown reasons. Secondary hypertension accounts for less than 10% of patients (Table 3-2).

TABLE 3-1Pathophysiology of Hypertension
TABLE 3-2Secondary Causes of Hypertension

Diagnosis

Hypertension is diagnosed when the average of two or three BP measurements are elevated at two or three separate clinical encounters. The 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, provide specific details for appropriate blood pressure measurement. Common errors in practice can occur by not following blood pressure technique recommendations leading to an inaccurate diagnosis or assessment of elevated blood pressure. Patients should be relaxed, sitting in a chair for at least 5 minutes. Refraining from caffeine, exercise and smoking is advised for ...

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