Hypertension: High Blood Pressure

Hypertension

• Hypertension, also known as high blood pressure, is a condition characterized by persistently elevated pressure within the arteries.
• It affects approximately 30% of adults in the United States, predominantly those over 60 years old.
• Hypertension is diagnosed when systolic blood pressure (SBP) is consistently ≥140 mm Hg and/or diastolic blood pressure (DBP) is consistently ≥90 mm Hg after repeated measurements.
• Severe hypertension is characterized by pressure above 180/120 mmHg.
• Untreated hypertension can lead to serious health complications including kidney failure, heart failure, myocardial infarction, stroke, and death.

Risk Factors for Hypertension

• Tobacco use/smoking
• Metabolic syndrome
• Obesity
• Dyslipidemia (abnormal blood fats)
• Diabetes
• Gender (males are disproportionately affected)
• Stress and anxiety
• Physical inactivity
• Age (those over 60 are at higher risk)
• High sodium diet
• Family history of cardiovascular disease

Hypertension Management

• Lifestyle modifications are crucial for managing hypertension, including a healthy diet, regular physical activity, stress reduction, and limiting alcohol/smoking.
• Drug therapy is often necessary, and different drug classes can target various aspects of the complex process, ranging from diuretics to calcium channel blockers.
• The specific therapy is chosen based on factors like the patient's age, risk factors, personal history, and comorbidities.

Key Points on Hypertension

• Hypertension is diagnosed based on repeated measurements.
• Guidelines differentiate between optimal (high-resource) and essential (low-resource) standards of care.
• Office BP is confirmed with measurements over multiple visits, considering cardiovascular conditions and validating diagnostic tools.

Special Considerations

• Pregnancy: Hypertension during pregnancy has specific categories and preferred medications.
• HMOD (Hypertension-Mediated Organ Damage): This encompasses damage to vital organs like the brain, heart, kidneys, arteries, and eyes, requiring specific interventions.
• Adherence: Ensuring patient adherence to treatment plans is critical for successful management.

Hypertension Treatments and Considerations

• Various classes of drugs have been developed to counteract/counterbalance hypertension issues. The most crucial are diuretics, ACE (angiotensin-converting enzyme) inhibitors, ARBs (angiotensin receptor blockers), and Calcium channel blockers. All of these operate on different parts of the body's systems involved in regulating and managing blood pressure.

• Treatment strategies should account for factors such as age, other existing health conditions, and potential drug interactions to optimize patient outcomes.

Medication Classes and Their Role in Hypertension

• Diuretics: Increase urination to reduce blood volume
• ACE Inhibitors: Block enzyme converting angiotensin I to angiotensin II
• ARBs: Specifically block angiotensin II.
• Calcium Channel Blockers: Relax blood vessels
• Beta-blockers: Slow heart rate and lower blood pressure
• Alpha-2 agonists: Reduce sympathetic nervous system activity.
• Direct-acting vasodilators: Directly relax blood vessels

Addressing Specific Hypertension Circumstances

• White Coat Hypertension: Elevated BP in clinical settings only.
• Masked Hypertension: Normal BP in clinics but elevated out-of-office.
• Resistant Hypertension: BP not controlled despite use of three or more antihypertensive agents, including a diuretic.

Hypertension, or high blood pressure, is when the pressure in your arteries is too high. Diagnosis occurs when systolic blood pressure is consistently ≥140 mm Hg and/or diastolic blood pressure is consistently ≥90 mm Hg. Uncontrolled hypertension can lead to heart issues, kidney failure, stroke and death.