Hypertension Module 7 PDF

**Hypertension** Hypertension, or **high blood pressure**, is a condition in which there is too much pressure in the arteries, often due to **vasoconstriction**. Hypertension is one of the most common conditions seen in primary care and affects approximately 30% of adults in the United States, most...

**Hypertension** Hypertension, or **high blood pressure**, is a condition in which there is too much pressure in the arteries, often due to **vasoconstriction**. Hypertension is one of the most common conditions seen in primary care and affects approximately 30% of adults in the United States, most of those over the age of 60. In accordance with most major guidelines it is recommended that hypertension be diagnosed when a person's **systolic blood pressure (SBP) in the office or clinic is ≥140 mm Hg and/or their diastolic blood pressure (DBP) is ≥90 mm Hg** following repeated examination, and is considered **severe if the pressure is above 180/120 mmHg. **It is often asymptomatic until organ damage occurs, making it challenging for adherence. If left untreated, it can cause health conditions such as kidney failure, heart failure, myocardial infarction, micro and macrovascular complications, stroke, and death.  It is important to note the risk factors associated with hypertension to decrease patients' risk of developing hypertension.  **Risk factors** for hypertension include: - - - - - - - - - - - Lowering other risk factors, such as avoiding drugs that can cause or exacerbate hypertension, is also recommended. Some of these can be examined in more detail in the table below: Insert table here  **Drug Class** **Common Examples** ----------------- ----------------------------------------------------------------------------------------------------------------------------------------- Estrogen Oral contraceptives Herbal Ephedra, gingseng, ma huang Illicit Amphetamines, cocaine NSAIDs Cyclooxygenase-2 inhibitors, ibuprofen, naproxen (Naprosyn^®^) Psychiatric Buspirone (Buspar^®^), carbamazepine (Tegretol^®^), clozapine (Clozaril^®^), fluoxetine (Prozac^®^), lithium, tricyclic antidepressants Steroid Methylprednisolone (Depo-Medrol^®^), prednisone Sympathomimetic Decongestants, diet pills **Guidelines** The most referenced guidelines on how to diagnose and treat hypertension have been published by the American College of Cardiology and the American Heart Association. Additional guidelines have been published by other organizations as well. **Key Points on the 2020 International Society of Hypertension (ISH) Global Hypertension Practice Guidelines** **1. Overview of Hypertension** - Hypertension is diagnosed when systolic blood pressure (SBP) ≥ 140 mm Hg and/or diastolic blood pressure (DBP) ≥ 90 mm Hg based on repeated measurements. - Guidelines differentiate between *optimal* (high-resource settings) and *essential* (low-resource settings) standards. **2. Diagnosis of Hypertension** - **Office BP Measurement:** - Confirm diagnosis with measurements across 2--3 visits at 1--4-week intervals unless BP is ≥180/110 mm Hg with cardiovascular disease evidence. - Use validated oscillometric devices. - **Out-of-Office BP Measurement:** - Recommended for accuracy, using ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM). - ABPM diagnostic thresholds: - 24-hour average: ≥130/80 mm Hg - Daytime average: ≥135/85 mm Hg - Nighttime average: ≥120/70 mm Hg **3. Hypertension Classifications** - **Office BP:** - Normal: \