Unbiased Analysis of Today's Healthcare Issues

What is hypertension?

Written By: Jason Shafrin - May• 28•14

What is hypertension?  How is it treated?  Below is a primer from a clinical guidelines paper from Weber et al. (2013).

Classifying Hypertension

  • Prehypertension: Systolic blood pressure between 120 mm Hg and 139 mm Hg, or diastolic pressures between 80 and 89 mm Hg.  Patients with this condition should not be treated with blood pressure medications; however, they should be encouraged to make lifestyle changes in the hope of delaying or even preventing progression to hypertension.
  • Stage 1 hypertension: patients with systolic blood pressure 140 to 159 mm Hg or diastolic blood pressure 90     to 99 mm Hg
  • Stage 2 hypertension: systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg

Primary vs. Secondary Hypertension

  • Primary: About 95% of adults with high blood pressure have primary hypertension (sometimes called essential hypertension). The cause of primary hypertension is not known, although genetic and environmental factors that affect blood pressure regulation are now being studied.
  • Secondary: About 5% of individuals have secondary hypertension where the cause of is due to chronic kidney disease

 

Additional questions physicians ask about.

  • Previous stroke, coronary artery disease, chronic kidney disease, diabetes, peripheral artery disease, or heart failure.  Certain anti-hypertensive medications may be preferred  based on patient comorbidities.
  • Sleep apnea.  Additional medication may be needed to improve blood pressure control.

Goals of hypertension treatment.

  • Generally systolic blood pressure is usually <140 mm Hg and for diastolic blood pressure <90 mm Hg

 

Treatment:

  • Non-pharmacologic: Weight loss, salt reduction, exercise, limit alcohol consumption to 1-2 per day, and stopping cigarette smoking.
  • Drug treatment.  Typically started if blood pressure is >140/90.  Pharmaceutical treatment is especially important for  Stage 2 hypertension.  Treatments include: angiotensin-converting enzyme  (ACE) inhibitor, angiotensin receptor blockers (ARB), alpha-blockers, beta-blocker, calcium channel blockers (CCB), and thiazide diuretic.  If none of these drugs works on its own, drug combinations can be used such as ACE inhibitors plus CCB or diuretics.

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