Hypertension  

Definition: 

Hypertension is a chronic elevation of arterial blood pressure. According to ACC/AHA 2017: 

– Normal: 110-130/60-80 mmHg 
– Elevated:  
– Stage 1: 130–139 or 80–89 mmHg 
– Stage 2: ≥140 or ≥90 mmHg 
 
Epidemiology: 
– Affects ~30–45% of adults worldwide 
– Major risk factor for cardiovascular disease, stroke, Chronic Kidney Disease, and heart failure 
 
Classification: 

1. Primary (Essential) Hypertension (90–95%) 
   – Multifactorial: genetics, RAAS activation, sympathetic overactivity 
 
2. Secondary Hypertension (5–10%) 
   – Renal: CKD, renal artery stenosis 
   – Endocrine: hyperaldosteronism, pheochromocytoma, Cushing’s disease  
   – Drugs: NSAIDs, OCPs, steroids 
   – Others: OSA, coarctation of aorta 
 
Pathophysiology: 
– Increased peripheral vascular resistance 
– Vascular remodeling 
– RAAS activation 
– Endothelial dysfunction 
 
Clinical Features: 
– Often asymptomatic 
– Headache, dizziness, visual changes in advanced disease 
 
Diagnosis: 
– Multiple BP readings on different occasions 
– Ambulatory or home BP monitoring recommended 
 
Target Organ Damage: 
– Heart: LV hypertrophy, CAD, heart failure 
– Brain: Stroke, vascular dementia 
– Kidneys: Nephrosclerosis, proteinuria 
– Eyes: Hypertensive retinopathy 
 
Management: 
Lifestyle: 
– Weight loss, DASH diet, reduced sodium 
– Exercise, limit alcohol, smoking cessation 
 
Pharmacologic: 
– ACE inhibitors 
– ARBs 
– Calcium channel blockers 
– Thiazide diuretics 
 
Hypertensive Crisis: 
– Urgency: ≥180/120 without organ damage 
– Emergency: ≥180/120 with organ damage (requires IV therapy) 
 
Key Points: 
– Most common cause of secondary HTN: renal disease 
– ACE inhibitors contraindicated in pregnancy