Understanding Hypertension and Blood Pressure

Definition of Hypertension

• Hypertension, or high blood pressure, is defined using guidelines from organizations like the American Heart Association.
• Diagnosis should be based on the average of two readings taken on two separate visits.

Blood Pressure Measurements

• Two key parameters are considered:
  • Systolic Blood Pressure: Pressure during ventricular contraction (systole).
  • Diastolic Blood Pressure: Pressure during ventricular relaxation (diastole).

Blood Pressure Categories

• Normal: Less than 120/80 mmHg.
• Elevated: 120-129 systolic and 80-89 diastolic mmHg.
• Stage 1 Hypertension: 130-139 systolic and 80-89 diastolic mmHg.
• Stage 2 Hypertension: Greater than 140 systolic or greater than 90 diastolic mmHg.

Types of Hypertension

• Isolated Systolic Hypertension: Elevated systolic (e.g., 135/74), with diastolic in normal range.
• Isolated Diastolic Hypertension: Elevated diastolic (e.g., 110/92), with systolic in normal range.

Special Considerations

• White Coat Hypertension: High blood pressure in the doctor's office but normal readings outside.
  • 24-hour ambulatory blood pressure monitoring can detect true blood pressure averages.
• Masked Hypertension: Normal blood pressure in the office but elevated outside.
  • Likewise, a 24-hour ambulatory blood pressure monitor helps in diagnosing this condition.

Key Diagnostic Criteria

• A reading of greater than 140/90 mmHg, especially after averaging two separate visits, is indicative of hypertension.### Primary Hypertension
• Definition: Essential or primary hypertension constitutes about 95% of hypertension cases.
• Age Factor: Most common in individuals aged 25-50 (sometimes up to 55).
• Family History: A strong indicator for essential hypertension diagnosis.
• Mechanisms:
  • Sympathetic Nervous System Activity: Increased norepinephrine and epinephrine lead to higher heart rates, increased cardiac output, and higher blood pressure.
  • Cardiac Output: Increased heart rate and stroke volume elevate blood pressure.
  • Vasoconstriction: Increased norepinephrine affects alpha-1 receptors, raising peripheral resistance and blood pressure.
  • Renin-Angiotensin-Aldosterone System (RAAS): Elevated renin leads to increased angiotensin II, further raising blood pressure.
• Risk Factors: Obesity, high sodium intake, stress, smoking, high lipids, and sedentary lifestyle.

Secondary Hypertension

• Definition: Accounts for about 5% of hypertension, often seen in younger patients with sudden, severe refractory hypertension.
• Common Causes:
  • Renal Disorders: Including renal artery stenosis and fibromuscular dysplasia, particularly in young women.
  • Diabetic Nephropathy: Associated with low glomerular filtration rates and elevated renin levels.
  • Medication Review: Consider drugs such as sympathomimetics (cocaine, amphetamines) and oral contraceptives containing estrogen.

Endocrine Causes of Hypertension

• Adrenal Issues:
  • Hyperaldosteronism: Increased sodium and water reabsorption leads to higher blood volume and blood pressure.
  • Cushing's Syndrome: Muscle weakness, "moon face," and increased sensitivity to catecholamines resulting in elevated blood pressure.
  • Pheochromocytoma: Adrenal tumor secreting epinephrine and norepinephrine, leading to paroxysmal hypertension.
• Thyroid Issues:
  • Hyperthyroidism: Increases heart rate and output while decreasing vessel tone.
  • Hypothyroidism: Increases vessel tone, raising peripheral resistance and blood pressure.
• Hyperparathyroidism: Elevated calcium levels in smooth muscles increase vascular contraction and blood pressure.

Cardiac Causes

• Coarctation of the Aorta: Results in high blood pressure in the upper body and low blood pressure in the lower body, often diagnosed through a discrepancy in pulses and blood pressures.

Complications of Hypertension

• Neurological: Increases risk of strokes, aneurysms, and hemorrhagic events due to vessel stress.
• Retinal Damage: Signs include AV nicking, cotton wool spots, and papilledema, indicating hypertensive retinopathy.
• Cardiac Complications: Risk of ischemic heart disease, left ventricular hypertrophy leading to heart failure, and arrhythmias (e.g., atrial fibrillation).
• Renal Complications: Chronic damage causing ischemia leading to renal failure, hematuria, and proteinuria (albuminuria).

Treatment of Hypertension

• Lifestyle Modifications: Weight loss, regular exercise, DASH diet, reduced sodium intake, and smoking cessation.
• First-Line Medications:
  • ACE Inhibitors (e.g., lisinopril): Beneficial for diabetes and chronic kidney disease patients but watch for cough and angioedema.
  • ARBs (e.g., losartan): Similar benefits to ACE inhibitors, less cough risk.
  • Dihydropyridine Calcium Channel Blockers (e.g., amlodipine): Useful for patients with low renin hypertension.
  • Thiazide Diuretics (e.g., hydrochlorothiazide): Helpful for sodium retention, caution in gout patients.
• Second-Line Medications:
  • Beta Blockers: Indicated for coronary artery disease and heart failure; caution in asthma and hypotension.
  • Aldosterone Antagonists (e.g., spironolactone): Beneficial in heart failure, monitor for hyperkalemia.

Hypertensive Crises

• Definitions:
  • Hypertensive Urgency: BP >180/120 without target organ damage.
  • Hypertensive Emergency: BP >180/120 with target organ damage requiring immediate treatment.
• Management: IV antihypertensives; gradual BP reduction targeting 25% in the first hour, followed by less than 160/100 within 2-6 hours.

Work-Up for Secondary Hypertension

• Renal Evaluation: Ultrasound for renal artery stenosis or blood flow reduction.
• Cardiovascular Assessment: Check for coarctation signs and imaging.
• Endocrine Testing: Evaluate aldosterone, cortisol levels, and urinary metanephrines.
• Thyroid Assessment: TSH levels reflect hypo/hyperthyroidism.
• Pregnancy Considerations: Proteinuria testing for preeclampsia/eclampsia.

This structured overview encapsulates essential aspects of hypertension, its causes, complications, and management strategies.### Hypertensive Emergencies

• Rapid reduction of blood pressure from dangerously high levels (e.g., 220/140 mmHg to 120/80 mmHg) can lead to serious complications.
• Abrupt drops in blood pressure may result in ischemic events due to inadequate perfusion, leading to:
  • Stroke from insufficient brain perfusion.
  • Myocardial infarction (MI) from compromised coronary perfusion.
  • Acute kidney injury from decreased renal perfusion.

Safe Blood Pressure Reduction

• It's critical to lower blood pressure slowly to mitigate risks associated with rapid changes.
• Common intravenous (IV) agents for controlled blood pressure management include:
  • Nicardipine: A calcium channel blocker, widely used for hypertensive emergencies.
  • Labetalol: A mixed alpha/beta-blocker, also frequently used.

Other IV Agents

• Additional medications that may be employed:
  • Hydralazine: A vasodilator that can help lower blood pressure.
  • Esmolol: A short-acting beta-blocker, beneficial in specific cases (e.g., aortic dissection).
  • Nitroprusside: Although effective, it's not commonly used due to potential toxicity.
  • Nitroglycerin: Useful in patients with left heart failure and pulmonary edema.

Importance of Hypertension Awareness

• Hypertension is a prevalent condition and often referred to as the "silent killer" due to its lack of symptoms.
• Understanding and recognizing hypertensive emergencies is crucial for preventing severe health consequences.

Definition of Hypertension

• Hypertension is defined as high blood pressure, following guidelines from the American Heart Association.
• Diagnoses rely on the average of two readings taken at separate visits.

Blood Pressure Measurements

• Systolic Blood Pressure: Measures pressure during heart ventricular contraction.
• Diastolic Blood Pressure: Measures pressure during heart ventricular relaxation.

Blood Pressure Categories

• Normal: Below 120/80 mmHg.
• Elevated: Systolic 120-129 and diastolic 80-89 mmHg.
• Stage 1 Hypertension: Systolic 130-139 and diastolic 80-89 mmHg.
• Stage 2 Hypertension: Systolic above 140 or diastolic above 90 mmHg.

Types of Hypertension

• Isolated Systolic Hypertension: Elevated systolic with normal diastolic levels.
• Isolated Diastolic Hypertension: Elevated diastolic with normal systolic levels.

Special Considerations

• White Coat Hypertension: High readings in the doctor's office but normal elsewhere.
• Masked Hypertension: Normal readings in the office but elevated outside.
• Both conditions can be evaluated with 24-hour ambulatory blood pressure monitoring.

Key Diagnostic Criteria

• Hypertension is indicated by readings above 140/90 mmHg, averaged over two visits.

Primary Hypertension

• Accounts for approximately 95% of all hypertension cases and is most common in individuals aged 25-55.
• Strongly linked to family history as a risk factor.
• Mechanisms include increased sympathetic nervous system activity, cardiac output, vasoconstriction, and the Renin-Angiotensin-Aldosterone System (RAAS).
• Risk factors: obesity, high sodium intake, stress, smoking, elevated lipids, and a sedentary lifestyle.

Secondary Hypertension

• Represents around 5% of cases, often presenting as sudden and severe hypertension.
• Common causes include renal disorders (renal artery stenosis, fibromuscular dysplasia), diabetic nephropathy, and certain medications.

Endocrine Causes of Hypertension

• Hyperaldosteronism: Increases blood volume due to sodium and water reabsorption.
• Cushing's Syndrome: Symptoms include muscle weakness and moon facies, leading to elevated blood pressure.
• Pheochromocytoma: An adrenal tumor increasing epinephrine and norepinephrine.
• Thyroid Disorders:
  • Hyperthyroidism: Heightened heart rate and lowered vessel tone.
  • Hypothyroidism: Increased vessel tone leading to higher resistance.
  • Hyperparathyroidism: Elevated calcium levels increase vascular contraction.

Cardiac Causes

• Coarctation of the Aorta: Presents with high upper body blood pressure and low lower body pressure, identified through pulse discrepancy.

Complications of Hypertension

• Neurological Risks: Higher chances of strokes, aneurysms, and hemorrhagic events.
• Retinal Damage: Indicators include AV nicking and cotton wool spots.
• Cardiac Complications: Increased risk of ischemic heart disease and heart failure.
• Renal Complications: Can lead to chronic renal failure and related symptoms.

Treatment of Hypertension

• Lifestyle Modifications: Focus on weight loss, exercise, DASH diet, reduced sodium, and quitting smoking.
• First-Line Medications:
  • ACE Inhibitors: Effective for diabetes patients but may cause cough.
  • ARBs: Similar to ACE inhibitors, less cough risk.
  • Calcium Channel Blockers: Effective for specific hypertension types.
  • Thiazide Diuretics: Caution advised in gout patients.
• Second-Line Medications:
  • Beta Blockers: Useful for coronary artery disease.
  • Aldosterone Antagonists: Watch for hyperkalemia risks.

Hypertensive Crises

• Definitions:
  • Hypertensive Urgency: Blood pressure above 180/120 without organ damage.
  • Hypertensive Emergency: Blood pressure above 180/120 with organ damage.
• Management involves gradual blood pressure reduction using IV antihypertensives, targeting 25% reduction in the first hour.

Work-Up for Secondary Hypertension

• Renal Assessment: Ultrasound to check for disorders like renal artery stenosis.
• Cardiovascular Evaluation: Check for signs of coarctation.
• Endocrine Testing: Assess hormone levels such as aldosterone and cortisol.
• Thyroid Assessment: Measure TSH levels.
• Consider testing for preeclampsia during pregnancy.

Importance of Hypertension Awareness

• Recognized as the "silent killer" for its asymptomatic nature; understanding emergencies is crucial for health outcomes.

Definition of Hypertension

• Hypertension is defined as high blood pressure, following guidelines from the American Heart Association.
• Diagnoses rely on the average of two readings taken at separate visits.

Blood Pressure Measurements

• Systolic Blood Pressure: Measures pressure during heart ventricular contraction.
• Diastolic Blood Pressure: Measures pressure during heart ventricular relaxation.

Blood Pressure Categories

• Normal: Below 120/80 mmHg.
• Elevated: Systolic 120-129 and diastolic 80-89 mmHg.
• Stage 1 Hypertension: Systolic 130-139 and diastolic 80-89 mmHg.
• Stage 2 Hypertension: Systolic above 140 or diastolic above 90 mmHg.

Types of Hypertension

• Isolated Systolic Hypertension: Elevated systolic with normal diastolic levels.
• Isolated Diastolic Hypertension: Elevated diastolic with normal systolic levels.

Special Considerations

• White Coat Hypertension: High readings in the doctor's office but normal elsewhere.
• Masked Hypertension: Normal readings in the office but elevated outside.
• Both conditions can be evaluated with 24-hour ambulatory blood pressure monitoring.

Key Diagnostic Criteria

• Hypertension is indicated by readings above 140/90 mmHg, averaged over two visits.

Primary Hypertension

• Accounts for approximately 95% of all hypertension cases and is most common in individuals aged 25-55.
• Strongly linked to family history as a risk factor.
• Mechanisms include increased sympathetic nervous system activity, cardiac output, vasoconstriction, and the Renin-Angiotensin-Aldosterone System (RAAS).
• Risk factors: obesity, high sodium intake, stress, smoking, elevated lipids, and a sedentary lifestyle.

Secondary Hypertension

• Represents around 5% of cases, often presenting as sudden and severe hypertension.
• Common causes include renal disorders (renal artery stenosis, fibromuscular dysplasia), diabetic nephropathy, and certain medications.

Endocrine Causes of Hypertension

• Hyperaldosteronism: Increases blood volume due to sodium and water reabsorption.
• Cushing's Syndrome: Symptoms include muscle weakness and moon facies, leading to elevated blood pressure.
• Pheochromocytoma: An adrenal tumor increasing epinephrine and norepinephrine.
• Thyroid Disorders:
  • Hyperthyroidism: Heightened heart rate and lowered vessel tone.
  • Hypothyroidism: Increased vessel tone leading to higher resistance.
  • Hyperparathyroidism: Elevated calcium levels increase vascular contraction.

Cardiac Causes

• Coarctation of the Aorta: Presents with high upper body blood pressure and low lower body pressure, identified through pulse discrepancy.

Complications of Hypertension

• Neurological Risks: Higher chances of strokes, aneurysms, and hemorrhagic events.
• Retinal Damage: Indicators include AV nicking and cotton wool spots.
• Cardiac Complications: Increased risk of ischemic heart disease and heart failure.
• Renal Complications: Can lead to chronic renal failure and related symptoms.

Treatment of Hypertension

• Lifestyle Modifications: Focus on weight loss, exercise, DASH diet, reduced sodium, and quitting smoking.
• First-Line Medications:
  • ACE Inhibitors: Effective for diabetes patients but may cause cough.
  • ARBs: Similar to ACE inhibitors, less cough risk.
  • Calcium Channel Blockers: Effective for specific hypertension types.
  • Thiazide Diuretics: Caution advised in gout patients.
• Second-Line Medications:
  • Beta Blockers: Useful for coronary artery disease.
  • Aldosterone Antagonists: Watch for hyperkalemia risks.

Hypertensive Crises

• Definitions:
  • Hypertensive Urgency: Blood pressure above 180/120 without organ damage.
  • Hypertensive Emergency: Blood pressure above 180/120 with organ damage.
• Management involves gradual blood pressure reduction using IV antihypertensives, targeting 25% reduction in the first hour.

Work-Up for Secondary Hypertension

• Renal Assessment: Ultrasound to check for disorders like renal artery stenosis.
• Cardiovascular Evaluation: Check for signs of coarctation.
• Endocrine Testing: Assess hormone levels such as aldosterone and cortisol.
• Thyroid Assessment: Measure TSH levels.
• Consider testing for preeclampsia during pregnancy.

Importance of Hypertension Awareness

• Recognized as the "silent killer" for its asymptomatic nature; understanding emergencies is crucial for health outcomes.

Definition of Hypertension

• Hypertension is defined as high blood pressure, following guidelines from the American Heart Association.
• Diagnoses rely on the average of two readings taken at separate visits.

Blood Pressure Measurements

• Systolic Blood Pressure: Measures pressure during heart ventricular contraction.
• Diastolic Blood Pressure: Measures pressure during heart ventricular relaxation.

Blood Pressure Categories

• Normal: Below 120/80 mmHg.
• Elevated: Systolic 120-129 and diastolic 80-89 mmHg.
• Stage 1 Hypertension: Systolic 130-139 and diastolic 80-89 mmHg.
• Stage 2 Hypertension: Systolic above 140 or diastolic above 90 mmHg.

Types of Hypertension

• Isolated Systolic Hypertension: Elevated systolic with normal diastolic levels.
• Isolated Diastolic Hypertension: Elevated diastolic with normal systolic levels.

Special Considerations

• White Coat Hypertension: High readings in the doctor's office but normal elsewhere.
• Masked Hypertension: Normal readings in the office but elevated outside.
• Both conditions can be evaluated with 24-hour ambulatory blood pressure monitoring.

Key Diagnostic Criteria

• Hypertension is indicated by readings above 140/90 mmHg, averaged over two visits.

Primary Hypertension

• Accounts for approximately 95% of all hypertension cases and is most common in individuals aged 25-55.
• Strongly linked to family history as a risk factor.
• Mechanisms include increased sympathetic nervous system activity, cardiac output, vasoconstriction, and the Renin-Angiotensin-Aldosterone System (RAAS).
• Risk factors: obesity, high sodium intake, stress, smoking, elevated lipids, and a sedentary lifestyle.

Secondary Hypertension

• Represents around 5% of cases, often presenting as sudden and severe hypertension.
• Common causes include renal disorders (renal artery stenosis, fibromuscular dysplasia), diabetic nephropathy, and certain medications.

Endocrine Causes of Hypertension

• Hyperaldosteronism: Increases blood volume due to sodium and water reabsorption.
• Cushing's Syndrome: Symptoms include muscle weakness and moon facies, leading to elevated blood pressure.
• Pheochromocytoma: An adrenal tumor increasing epinephrine and norepinephrine.
• Thyroid Disorders:
  • Hyperthyroidism: Heightened heart rate and lowered vessel tone.
  • Hypothyroidism: Increased vessel tone leading to higher resistance.
  • Hyperparathyroidism: Elevated calcium levels increase vascular contraction.

Cardiac Causes

• Coarctation of the Aorta: Presents with high upper body blood pressure and low lower body pressure, identified through pulse discrepancy.

Complications of Hypertension

• Neurological Risks: Higher chances of strokes, aneurysms, and hemorrhagic events.
• Retinal Damage: Indicators include AV nicking and cotton wool spots.
• Cardiac Complications: Increased risk of ischemic heart disease and heart failure.
• Renal Complications: Can lead to chronic renal failure and related symptoms.

Treatment of Hypertension

• Lifestyle Modifications: Focus on weight loss, exercise, DASH diet, reduced sodium, and quitting smoking.
• First-Line Medications:
  • ACE Inhibitors: Effective for diabetes patients but may cause cough.
  • ARBs: Similar to ACE inhibitors, less cough risk.
  • Calcium Channel Blockers: Effective for specific hypertension types.
  • Thiazide Diuretics: Caution advised in gout patients.
• Second-Line Medications:
  • Beta Blockers: Useful for coronary artery disease.
  • Aldosterone Antagonists: Watch for hyperkalemia risks.

Hypertensive Crises

• Definitions:
  • Hypertensive Urgency: Blood pressure above 180/120 without organ damage.
  • Hypertensive Emergency: Blood pressure above 180/120 with organ damage.
• Management involves gradual blood pressure reduction using IV antihypertensives, targeting 25% reduction in the first hour.

Work-Up for Secondary Hypertension

• Renal Assessment: Ultrasound to check for disorders like renal artery stenosis.
• Cardiovascular Evaluation: Check for signs of coarctation.
• Endocrine Testing: Assess hormone levels such as aldosterone and cortisol.
• Thyroid Assessment: Measure TSH levels.
• Consider testing for preeclampsia during pregnancy.

Importance of Hypertension Awareness

• Recognized as the "silent killer" for its asymptomatic nature; understanding emergencies is crucial for health outcomes.

Definition of Hypertension

• Hypertension is defined as high blood pressure, following guidelines from the American Heart Association.
• Diagnoses rely on the average of two readings taken at separate visits.

Blood Pressure Measurements

• Systolic Blood Pressure: Measures pressure during heart ventricular contraction.
• Diastolic Blood Pressure: Measures pressure during heart ventricular relaxation.

Blood Pressure Categories

• Normal: Below 120/80 mmHg.
• Elevated: Systolic 120-129 and diastolic 80-89 mmHg.
• Stage 1 Hypertension: Systolic 130-139 and diastolic 80-89 mmHg.
• Stage 2 Hypertension: Systolic above 140 or diastolic above 90 mmHg.

Types of Hypertension

• Isolated Systolic Hypertension: Elevated systolic with normal diastolic levels.
• Isolated Diastolic Hypertension: Elevated diastolic with normal systolic levels.

Special Considerations

• White Coat Hypertension: High readings in the doctor's office but normal elsewhere.
• Masked Hypertension: Normal readings in the office but elevated outside.
• Both conditions can be evaluated with 24-hour ambulatory blood pressure monitoring.

Key Diagnostic Criteria

• Hypertension is indicated by readings above 140/90 mmHg, averaged over two visits.

Primary Hypertension

• Accounts for approximately 95% of all hypertension cases and is most common in individuals aged 25-55.
• Strongly linked to family history as a risk factor.
• Mechanisms include increased sympathetic nervous system activity, cardiac output, vasoconstriction, and the Renin-Angiotensin-Aldosterone System (RAAS).
• Risk factors: obesity, high sodium intake, stress, smoking, elevated lipids, and a sedentary lifestyle.

Secondary Hypertension

• Represents around 5% of cases, often presenting as sudden and severe hypertension.
• Common causes include renal disorders (renal artery stenosis, fibromuscular dysplasia), diabetic nephropathy, and certain medications.

Endocrine Causes of Hypertension

• Hyperaldosteronism: Increases blood volume due to sodium and water reabsorption.
• Cushing's Syndrome: Symptoms include muscle weakness and moon facies, leading to elevated blood pressure.
• Pheochromocytoma: An adrenal tumor increasing epinephrine and norepinephrine.
• Thyroid Disorders:
  • Hyperthyroidism: Heightened heart rate and lowered vessel tone.
  • Hypothyroidism: Increased vessel tone leading to higher resistance.
  • Hyperparathyroidism: Elevated calcium levels increase vascular contraction.

Cardiac Causes

• Coarctation of the Aorta: Presents with high upper body blood pressure and low lower body pressure, identified through pulse discrepancy.

Complications of Hypertension

• Neurological Risks: Higher chances of strokes, aneurysms, and hemorrhagic events.
• Retinal Damage: Indicators include AV nicking and cotton wool spots.
• Cardiac Complications: Increased risk of ischemic heart disease and heart failure.
• Renal Complications: Can lead to chronic renal failure and related symptoms.

Treatment of Hypertension

• Lifestyle Modifications: Focus on weight loss, exercise, DASH diet, reduced sodium, and quitting smoking.
• First-Line Medications:
  • ACE Inhibitors: Effective for diabetes patients but may cause cough.
  • ARBs: Similar to ACE inhibitors, less cough risk.
  • Calcium Channel Blockers: Effective for specific hypertension types.
  • Thiazide Diuretics: Caution advised in gout patients.
• Second-Line Medications:
  • Beta Blockers: Useful for coronary artery disease.
  • Aldosterone Antagonists: Watch for hyperkalemia risks.

Hypertensive Crises

• Definitions:
  • Hypertensive Urgency: Blood pressure above 180/120 without organ damage.
  • Hypertensive Emergency: Blood pressure above 180/120 with organ damage.
• Management involves gradual blood pressure reduction using IV antihypertensives, targeting 25% reduction in the first hour.

Work-Up for Secondary Hypertension

• Renal Assessment: Ultrasound to check for disorders like renal artery stenosis.
• Cardiovascular Evaluation: Check for signs of coarctation.
• Endocrine Testing: Assess hormone levels such as aldosterone and cortisol.
• Thyroid Assessment: Measure TSH levels.
• Consider testing for preeclampsia during pregnancy.

Importance of Hypertension Awareness

• Recognized as the "silent killer" for its asymptomatic nature; understanding emergencies is crucial for health outcomes.

Definition of Hypertension

• Hypertension is defined as high blood pressure, following guidelines from the American Heart Association.
• Diagnoses rely on the average of two readings taken at separate visits.

Blood Pressure Measurements

• Systolic Blood Pressure: Measures pressure during heart ventricular contraction.
• Diastolic Blood Pressure: Measures pressure during heart ventricular relaxation.

Blood Pressure Categories

• Normal: Below 120/80 mmHg.
• Elevated: Systolic 120-129 and diastolic 80-89 mmHg.
• Stage 1 Hypertension: Systolic 130-139 and diastolic 80-89 mmHg.
• Stage 2 Hypertension: Systolic above 140 or diastolic above 90 mmHg.

Types of Hypertension

• Isolated Systolic Hypertension: Elevated systolic with normal diastolic levels.
• Isolated Diastolic Hypertension: Elevated diastolic with normal systolic levels.

Special Considerations

• White Coat Hypertension: High readings in the doctor's office but normal elsewhere.
• Masked Hypertension: Normal readings in the office but elevated outside.
• Both conditions can be evaluated with 24-hour ambulatory blood pressure monitoring.

Key Diagnostic Criteria

• Hypertension is indicated by readings above 140/90 mmHg, averaged over two visits.

Primary Hypertension

• Accounts for approximately 95% of all hypertension cases and is most common in individuals aged 25-55.
• Strongly linked to family history as a risk factor.
• Mechanisms include increased sympathetic nervous system activity, cardiac output, vasoconstriction, and the Renin-Angiotensin-Aldosterone System (RAAS).
• Risk factors: obesity, high sodium intake, stress, smoking, elevated lipids, and a sedentary lifestyle.

Secondary Hypertension

• Represents around 5% of cases, often presenting as sudden and severe hypertension.
• Common causes include renal disorders (renal artery stenosis, fibromuscular dysplasia), diabetic nephropathy, and certain medications.

Endocrine Causes of Hypertension

• Hyperaldosteronism: Increases blood volume due to sodium and water reabsorption.
• Cushing's Syndrome: Symptoms include muscle weakness and moon facies, leading to elevated blood pressure.
• Pheochromocytoma: An adrenal tumor increasing epinephrine and norepinephrine.
• Thyroid Disorders:
  • Hyperthyroidism: Heightened heart rate and lowered vessel tone.
  • Hypothyroidism: Increased vessel tone leading to higher resistance.
  • Hyperparathyroidism: Elevated calcium levels increase vascular contraction.

Cardiac Causes

• Coarctation of the Aorta: Presents with high upper body blood pressure and low lower body pressure, identified through pulse discrepancy.

Complications of Hypertension

• Neurological Risks: Higher chances of strokes, aneurysms, and hemorrhagic events.
• Retinal Damage: Indicators include AV nicking and cotton wool spots.
• Cardiac Complications: Increased risk of ischemic heart disease and heart failure.
• Renal Complications: Can lead to chronic renal failure and related symptoms.

Treatment of Hypertension

• Lifestyle Modifications: Focus on weight loss, exercise, DASH diet, reduced sodium, and quitting smoking.
• First-Line Medications:
  • ACE Inhibitors: Effective for diabetes patients but may cause cough.
  • ARBs: Similar to ACE inhibitors, less cough risk.
  • Calcium Channel Blockers: Effective for specific hypertension types.
  • Thiazide Diuretics: Caution advised in gout patients.
• Second-Line Medications:
  • Beta Blockers: Useful for coronary artery disease.
  • Aldosterone Antagonists: Watch for hyperkalemia risks.

Hypertensive Crises

• Definitions:
  • Hypertensive Urgency: Blood pressure above 180/120 without organ damage.
  • Hypertensive Emergency: Blood pressure above 180/120 with organ damage.
• Management involves gradual blood pressure reduction using IV antihypertensives, targeting 25% reduction in the first hour.

Work-Up for Secondary Hypertension

• Renal Assessment: Ultrasound to check for disorders like renal artery stenosis.
• Cardiovascular Evaluation: Check for signs of coarctation.
• Endocrine Testing: Assess hormone levels such as aldosterone and cortisol.
• Thyroid Assessment: Measure TSH levels.
• Consider testing for preeclampsia during pregnancy.

Importance of Hypertension Awareness

• Recognized as the "silent killer" for its asymptomatic nature; understanding emergencies is crucial for health outcomes.

This quiz provides insights into the definition and measurement of hypertension. It covers key parameters, categories, and types of high blood pressure according to guidelines by health organizations. Test your knowledge on systolic and diastolic pressure readings along with their classifications.