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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.

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  • High blood pressure

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  • Persistently elevated arterial blood pressure (BP).

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  • Primary (essential) hypertension: unknown cause.
  • Secondary hypertension
    • Chronic kidney disease (CKD) or renovascular disease
    • Cushing’s syndrome
    • Coarctation of aorta
    • Obstructive sleep apnea
    • Hyperparathyroidism
    • Pheochromocytoma
    • Primary aldosteronism
    • Drugs, including:
      • Corticosteroids
      • Estrogens
      • Nonsteroidal anti-inflammatory drugs (NSAIDs)
      • Amphetamines
      • Sibutramine
      • Cyclosporine
      • Tacrolimus
      • Erythropoietin
      • Venlafaxine

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  • 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 for:
    • 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.

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  • 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 fifth decades.

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  • Increase physical activity.
  • Limit alcohol consumption.
  • Limit sodium intake.
  • Consume diet rich in fruits, vegetables, and low-fat dairy products.

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  • Increasing age
  • Race
  • Family history
  • Obesity
  • Physical inactivity
  • Smoking
  • Excessive sodium or inadequate potassium intake
  • Excessive alcohol consumption
  • Chronic conditions (e.g., kidney disease)

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Signs and Symptoms

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  • Symptoms
    • Uncomplicated primary hypertension usually asymptomatic initially.
    • Patients with pheochromocytoma may have:
      • Headaches
      • Sweating
      • Tachycardia
      • Palpitations
      • 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
      • Polyuria
      • Edema
      • Menstrual irregularities
      • Acne
      • Muscular weakness
      • Moon face
      • Buffalo hump
      • Hirsutism
  • Signs
    • Funduscopic exam:
      • Arteriolar narrowing
      • Arteriovenous nicking
      • Retinal hemorrhages and exudates
      • Papilledema
    • Heart:
      • Abnormal rate or rhythm
      • Left ventricular (LV) hypertrophy
      • Coronary heart disease
      • Heart failure (HF)
    • Peripheral vascular:
      • Aortic or abdominal bruits
      • Distended veins
      • Diminished or absent peripheral pulses
      • Lower-extremity edema

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Means of Confirmation and Diagnosis

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  • Diagnosis based on average of ≥2 readings taken at each of ≥2 visits (Table 1).

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Table Graphic Jump Location
Table 1. Classification of Blood Pressure in Adults
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Laboratory Tests

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  • First-line tests:
    • Blood urea nitrogen (BUN)/serum creatinine
    • Fasting lipid panel
    • Fasting blood glucose
    • Serum electrolytes
    • Spot urine albumin-to-creatinine ratio
    • Estimated glomerular filtration rate
    • Urinalysis
  • For secondary hypertension:
    • Plasma norepinephrine and urinary metanephrine levels
    • Plasma and urinary aldosterone concentrations
    • Plasma renin activity
    • Captopril stimulation test
    • ...

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