Source: Saseen JJ, MacLaughlin
EJ. Hypertension. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells
BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7969921.
Accessed June 29, 2012.
- Persistently elevated arterial blood pressure (BP).
- Primary (essential) hypertension: unknown cause.
- Secondary hypertension
kidney disease (CKD) or renovascular disease
- Cushing’s syndrome
- Coarctation of aorta
- Obstructive sleep apnea
- Primary aldosteronism
- Drugs, including:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Abnormalities involving renin–angiotensin–aldosterone
system, natriuretic hormone, or insulin resistance.
- Disturbance in the central nervous system (CNS), autonomic
nerve fibers, adrenergic receptors, or baroreceptors.
- Abnormalities in renal or tissue autoregulatory processes
- Sodium excretion
- Plasma volume
- Arteriolar constriction
- Deficiency in synthesis of vasodilators in vascular endothelium
(prostacyclin, bradykinin, nitric oxide) or excess vasoconstrictors
(angiotensin II, endothelin I).
- High sodium intake or lack of dietary calcium.
- Approximately 31% of Americans (74.5 million
people) have elevated BP.
- Overall incidence is similar between men and women, but varies
depending on age.
- Prevalence rates are highest in non-Hispanic blacks, followed
by non-Hispanic whites, Mexican Americans, American Indians/Alaska
Natives, and Asians.
- Most diagnoses occurring between third and
- Increase physical activity.
- Limit alcohol consumption.
- Limit sodium intake.
- Consume diet rich in fruits, vegetables, and low-fat dairy
- Increasing age
- Family history
- Physical inactivity
- Excessive sodium or inadequate potassium intake
- Excessive alcohol consumption
- Chronic conditions (e.g., kidney disease)
- Uncomplicated primary hypertension
usually asymptomatic initially.
- Patients with pheochromocytoma may have:
- Orthostatic hypotension
- In primary aldosteronism, hypokalemic symptoms of muscle cramps
and weakness may be present.
- Patients with Cushing’s syndrome may complain of:
- Weight gain
- Menstrual irregularities
- Muscular weakness
- Moon face
- Buffalo hump
- Funduscopic exam:
- Arteriovenous nicking
- Retinal hemorrhages and exudates
- Abnormal rate or rhythm
- Left ventricular (LV) hypertrophy
- Coronary heart disease
- Heart failure (HF)
- Peripheral vascular:
- Aortic or abdominal
- Distended veins
- Diminished or absent peripheral pulses
- Lower-extremity edema
Means of Confirmation
- Diagnosis based on average of ≥2 readings taken at each
of ≥2 visits (Table 1).
Table 1. Classification
of Blood Pressure in Adults |Favorite Table|Download (.pdf)
Table 1. Classification
of Blood Pressure in Adults
|Classification||Systolic (mm Hg)||Diastolic (mm Hg)|
|Stage 1 hypertension||140–159||or||90–99|
|Stage 2 hypertension||≥160||or||≥100|
|Isolated systolic hypertension||≥140||and ||<90|
- First-line tests:
- Blood urea nitrogen
- Fasting lipid panel
- Fasting blood glucose
- Serum electrolytes
- Spot urine albumin-to-creatinine ratio
- Estimated glomerular filtration rate
- For secondary hypertension:
- Plasma norepinephrine
and urinary metanephrine levels
- Plasma and urinary aldosterone concentrations
- Plasma renin activity...