Hypertension Definitions

Definitions (Guidelines updated in 2017):

 

Blood Pressure Classification

    Systolic Pressure

    Diastolic Pressure

            Normal

             <120

              And <80

Elevated Blood Pressure

           120-129

              <80     

Stage I Hypertension

           130-139

              Or 80-89

Stage II Hypertension

            >140

              Or >90

White Coat Hypertension = Elevated Blood pressure during office visits only and normal at home.

Masked Hypertension = Normal Blood Pressure at the office and high at home

Malignant Hypertension = Elevated Blood Pressure leading to vital organs damage

Hypertensive Urgency = Elevated blood pressure without any symptom

Hypertensive Emergency = Elevated blood pressure with symptoms related to organ dysfunction caused by the abnormal blood pressure for example High blood pressure with headache or chest pain

Classification of Hypertension According to Cause

Primary Hypertension (90%) = Elevated blood pressure due to hardening of the arteries and genetic factors

hypertension
hypertension

Secondary Hypertension (10%) = Elevated blood pressure caused by either kidney disease , Excessive hormones secretion, Obstructive Sleep apnea or Coarctation of Aorta

high blood pressure
  • Kidney disease and kidney artery stenosis (narrowing)
  • Thyroid over or under production of hormones
  • Parathyroid glands over production of hormones
  • Adrenal Gland Tumors (Pheochromocytoma)
  • Obstructive Sleep Apnea
  • Coarctation of Aorta

 

Results of Untreated Sustained Hypertension on Vital Organs

Organ

Chronic Changes

Acute Complications

Eye

diabetes and eye

Retinopathy

Optic Neuropathy

May lead to gradual visual loss

Papilledema (swelling of the optic disc)

May lead to sudden vision loss and blindness

 

 

Brain

mini stroke

Decreased brain circulation with increased risk of mini stroke and dementia

May lead to gradual brain function deterioration 

Brain bleed
Seizure
Altered mental status 

May lead to major stroke or fatality

Heart

heart muscle thickness

Heart muscle thickness

(Hypertrophy) and weakness (Heart Failure)

May lead to chest pain and shortness of breath

Heart Attack and/or Failure
  

May cause chest pain.
If not fatal it can reduce the heart pump strength and lead to chronic heart failure

Kidney

high blood pressure and kidney

Gradual kidney scarring and loss of function

May lead to symptoms of gradual slowly progressive kidney failure

Acute kidney injury and failure

  May need Dialysis

Meduim and Large Blood Vessels

blood pressure

Peripheral Vascular disease and poor circulation

Weakness,Pain, numbness and intermittent claudication

Aortic Aneurysm and dissection

May cause acute chest and back pain or abdomen pain

May be fatal

Management of patient with NEWLY DISCOVERED high blood pressure
***Please notify your physician of your BP reading for appointment and evaluation
high blood pressure

Hypertension Initial Evaluation Goals

The Goal of the primary care office evaluation is:

  • To rule out secondary (curable) cause of hypertension (Kidney and hormones)
  • To assess and treat other modifiable causes of vascular diseases like high cholesterol and Diabetes
  • To assess the presence and severity of hypertension related organ disease if any

Initial Testing Recommended for New Onset Hypertension

    • EKG
    • Blood Testing: CBC, Metabolic Panel, estimated GFR, Lipid Panel, Fasting Blood Sugar and Thyroid function
    • Urinalysis with Microscopic exam and Urine Albumin
    • More specific testing can be recommended if the initial evaluation is suspicious for secondary hypertension (Kidney disease or Hormone excess

Overview of Hypertension Treatment

Life Style Modifications
  • Weight Reduction
  • Reduce dietary salt
  • DASH diet (Fruits, Vegetables, Low fat dairy, Whole grain, Legumes, Low saturated fat, low Sodium, High Potassium, Magnesium and Calcium
  • Increase Potassium
  • Daily exercise
Treatment Target
  • Elderly Not in nursing home —> BP <130/80
  • Non Elderly —> BP < 130/80
  • Diabetes —> BP < 130/80
  • Kidney Disease —> BP < 130/80
Medical Treatment
  • You may start with any of the following:
    •  Calcium Channel Blocker
    • Ace Inhibitor or ARB
    • Chlorthalidone
  • 2 medications are recommended for stage 2 hypertension
  • Re-evaluation is recommended at 4 weeks interval to assess response to medical treatment and need for dose adjustment
  • In Black you may start with either Calcium Channel Blocker or Thiazides Diuretic
  • Other classes of antihypertensives can be used in specific situations 
  • Resistant hypertension should raise suspicion for secondary causes

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