Hypertension is a condition with consistently high force of blood against arteries. It is also called High blood pressure.
Blood pressure measured in mmHg, which consists of two numbers:
Systolic i.e., During heartbeat over Diastolic i.e., Between heartbeats pressure.
Normal blood pressure is generally noted as 120/80 mmHg.
Primary and secondary these are two types of hypertensions, and the risk factors include genetics, age and lifestyle.
High blood pressure key risk factor for heart issues, stroke, kidney disease, peripheral vascular problems.
Primary hypertension is the most common type, without a clear cause it affects 90% to95% of adults with hypertension while secondary hypertension shows 5% to 10% cases.
Hypertensive emergencies show target organ dysfunction, while hypertensive urgencies are situations without target organ dysfunction.
Epidemiology
Hypertension is a global epidemic condition. In the US national health and nutrition examination survey data from 2011 to 2014 shows 86 million adults more than 20 years observed hypertension, which represents a 34% prevalence rate in the population.
Hypertension rates decreased in the early 2000s then again rises in 2014, with a noticeable increase among men in recent years.
Around 972 million people worldwide shows hypertension cases, with prevalence expected to increase up to 29% by 2025 in developing countries.
Black adults in the US and worldwide have high rates of hypertension. White adults may develop high BP later in their life and have lower average as compared to Black adults.
Anatomy
Pathophysiology
Primary hypertension has complex pathogenesis with multiple factors which affects blood pressure includes vascular reactivity, blood volume, and neural stimulation.
Primary hypertension progresses from occasional to established to complicated, that causes end-organ damage in the aorta, small arteries, heart, kidneys, and central nervous system as time passes.
Vascular changes cause increased systemic vascular resistance, and cardiac output stays slightly reduced with normal blood volume.
Etiology
Hypertension caused due to environmental factors and complex gene inheritance along with genetic components.
DNA methylation and histone modification are linked with hypertension. High salt diets may cause nephron development due to methylation.
Mental stress initiates DNA methylase, increase autonomic response and methylation pattern predicts preeclampsia risk in pregnancy.
Rare genetic causes of hypertension include Liddle syndrome, glucocorticoid-remediable hyperaldosteronism, and deficiencies in alpha-hydroxylase enzymes.
Genetics
Prognostic Factors
Untreated hypertension worsens with age and increases mortality risk thus called as silent killer because it increases blood pressure.
Patients with resistant hypertension and comorbidities have higher risk for poor outcomes. Lower blood pressure may reduce risk for cardiovascular events.
Mortality from ischemic heart disease and stroke rises with higher blood pressure.
Outcome in hypertensive emergencies is influenced by initial organ damage and subsequent blood pressure control.
Hypertension increases risk of end-stage renal disease in Black patients even diabetic nephropathy patients with hypertension also at risk.
Clinical History
Hypertension occurs more in youth till age of 20 due to rising obesity and sedentary behaviors.
Hypertension increases significantly in individuals between 30 to 60 years old.
Physical Examination
Blood Pressure Measurement
Respiratory Examination
Cardiovascular Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
High blood pressure develops slowly over the years, sometimes without any noticeable symptoms.
Severe high blood pressure causes organ damage in hypertensive emergencies.
Differential Diagnoses
Primary Hypertension
Secondary Hypertension
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Middle-aged to elderly individuals with a family history of hypertension are affected and slight reduction can lower blood pressure.
First-line medications for hypertension includes ACE inhibitors/ARBs, calcium channel blockers, and thiazide diuretics.
Hypertension common in diabetic cases, it raises risk by 2.5 times in 5 years. Both conditions also increased risk of cardiovascular disease, stroke, and renal disease.
Physician aims to identify acute hypertension patients with end-organ damage symptoms needing urgent antihypertensive therapy. Initial therapy for acutely ill infants with severe hypertension is continuous IV infusions.
Therapy for renovascular hypertension aims to maintain normal blood pressure and prevent end-stage renal disease through various treatments.
Pseudo-hypertension may occur when high blood pressure is observed without actual organ damage, hypotensive symptoms from medications.
Surgical resection is preferred for pheochromocytoma as it cures hypertension. Preoperative alpha-adrenergic blockade with phenoxybenzamine is followed by beta-adrenergic blockade for tachycardia.
Patients should start walking, swimming, and cycling to improve heart condition under physician guidance.
Include healthy diet such as fruits, vegetables, whole grains, and avoid unhealthy food.
Psychological support is essential for managing stress, anxiety, and depression in heart patients. Use blood pressure measuring device and record blood pressure levels regularly.
Breathing exercises is effective to control blood pressure also yoga exercises help in hypertension. Lifestyle modification like intake of healthy nutritional supplements and proper hydration should be followed by patients.
Appointments with a cardiologist and preventing recurrence of disorder is an ongoing life-long effort.
Use of Thiazide Diuretics
Hydrochlorothiazide:
It is approved to manage hypertension alone or with other agents. It can be used in patients on ACE inhibitors.
Use of Potassium-Sparing Diuretics
Triamterene:
It raises potassium levels and use caution when combining with drugs that increase potassium.
Amiloride:
It is a potassium-conserving drug with mild effects compared to thiazide diuretics, that are used in hypertension and heart failure treatment.
Use of loop Diuretics
Furosemide:
Inadequately controlled hypertensive patients with thiazides may not respond to furosemide.
Torsemide:
It can be used alone or with other antihypertensives. Take a dose of 5 mg daily, then increase up to 10 mg.
Use of Angiotensin converting enzyme inhibitors (ACEIs)
Captopril:
It inhibits angiotensin conversion, activates bradykinin, which regulates blood pressure effectively.
Ramipril:
It relaxes blood vessels has widen easier blood flow. This reduces strain on the heart and improves circulation efficiency.
Use of angiotensin receptor blockers (ARBs)
Losartan:
It relaxes blood vessels and lowers blood pressure, which increases blood and oxygen to the heart.
Valsartan:
It blocks the RAAS system, which inhibits neprilysin causing angiotensin II accumulation from breakdown prevention.
Use of Beta-Blockers (Beta-1 Selective)
Atenolol:
It treats angina, which improves survival post-heart attack, relaxes blood vessels, slows heart rate and reduces blood pressure.
Propranolol:
It competes with sympathomimetic neurotransmitters for non-selective beta receptor binding without preference for β1 or β2.
Use of Vasodilators
Hydralazine:
It reduces blood pressure through direct relaxation of vascular smooth muscle.
Minoxidil:
It is used for severe symptomatic hypertension with end-organ damage unresponsive to diuretic and antihypertensives.
Use of Calcium channel blockers
Amlodipine:
It inhibits calcium ions during depolarization in smooth muscle and myocardium.
Verapamil:
It is a non-dihydropyridine antihypertensive that works on both vascular and cardiac systems, which acts as a vasodilator.
Eplerenone:
It blocks aldosterone at receptors, which lowers BP and sodium reabsorption.
Use of Renin Inhibitors
Aliskiren:
It lowers plasma renin, that inhibits angiotensinogen conversion and disrupts renin-angiotensin-aldosterone system feedback loop.
Use of Alpha-Blockers in Antihypertensives
Prazosin:
It blocks alpha1-receptors, that leads to peripheral vasodilation through vascular inhibition.
Doxazosin:
It inhibits alpha-adrenergic receptors, which causes vasodilation, decreased peripheral resistance, and lowered blood pressure.
Use of Antihypertensives
Reserpine:
It depletes biogenic amines, that causes sympathetic dysfunction and reduced peripheral vascular resistance and lowers blood pressure.
Use of Endothelin Antagonists
Aprocitentan:
It is used to treat hypertension in adults not controlled on other antihypertensive drugs which lowers blood pressure.
Revascularization for renovascular hypertension with aortorenal bypass using saphenous vein graft or hypogastric artery.
Surgery is preferred for pheochromocytoma and aldosterone-producing adenoma to cure hypertension through tumor removal.
Angioplasty in fibromuscular dysplasia of renal artery has 60% to 80% hypertension resolution success.
use-of-phases-in-managing-hypertension
In the diagnosis phase, evaluation includes detailed patient history of cardiovascular disorders, elevated blood pressure and associated symptoms.
In supportive care and management phase, patients should receive all the required attention in the form of postoperative care, monitoring, and rehabilitation.
Track blood pressure on daily basis and note medication side effects if occurs also start follow up with physician in every 1 to 2 months until blood pressure is controlled.
Pharmacologic therapy is very effective in the treatment as it includes first-line medications and combination therapy.
The regular follow-up visits with the cardiologist are schedule to check the improvement of patients along with treatment response.
Hypertension is a condition with consistently high force of blood against arteries. It is also called High blood pressure.
Blood pressure measured in mmHg, which consists of two numbers:
Systolic i.e., During heartbeat over Diastolic i.e., Between heartbeats pressure.
Normal blood pressure is generally noted as 120/80 mmHg.
Primary and secondary these are two types of hypertensions, and the risk factors include genetics, age and lifestyle.
High blood pressure key risk factor for heart issues, stroke, kidney disease, peripheral vascular problems.
Primary hypertension is the most common type, without a clear cause it affects 90% to95% of adults with hypertension while secondary hypertension shows 5% to 10% cases.
Hypertensive emergencies show target organ dysfunction, while hypertensive urgencies are situations without target organ dysfunction.
Hypertension is a global epidemic condition. In the US national health and nutrition examination survey data from 2011 to 2014 shows 86 million adults more than 20 years observed hypertension, which represents a 34% prevalence rate in the population.
Hypertension rates decreased in the early 2000s then again rises in 2014, with a noticeable increase among men in recent years.
Around 972 million people worldwide shows hypertension cases, with prevalence expected to increase up to 29% by 2025 in developing countries.
Black adults in the US and worldwide have high rates of hypertension. White adults may develop high BP later in their life and have lower average as compared to Black adults.
Primary hypertension has complex pathogenesis with multiple factors which affects blood pressure includes vascular reactivity, blood volume, and neural stimulation.
Primary hypertension progresses from occasional to established to complicated, that causes end-organ damage in the aorta, small arteries, heart, kidneys, and central nervous system as time passes.
Vascular changes cause increased systemic vascular resistance, and cardiac output stays slightly reduced with normal blood volume.
Hypertension caused due to environmental factors and complex gene inheritance along with genetic components.
DNA methylation and histone modification are linked with hypertension. High salt diets may cause nephron development due to methylation.
Mental stress initiates DNA methylase, increase autonomic response and methylation pattern predicts preeclampsia risk in pregnancy.
Rare genetic causes of hypertension include Liddle syndrome, glucocorticoid-remediable hyperaldosteronism, and deficiencies in alpha-hydroxylase enzymes.
Untreated hypertension worsens with age and increases mortality risk thus called as silent killer because it increases blood pressure.
Patients with resistant hypertension and comorbidities have higher risk for poor outcomes. Lower blood pressure may reduce risk for cardiovascular events.
Mortality from ischemic heart disease and stroke rises with higher blood pressure.
Outcome in hypertensive emergencies is influenced by initial organ damage and subsequent blood pressure control.
Hypertension increases risk of end-stage renal disease in Black patients even diabetic nephropathy patients with hypertension also at risk.
Hypertension occurs more in youth till age of 20 due to rising obesity and sedentary behaviors.
Hypertension increases significantly in individuals between 30 to 60 years old.
Blood Pressure Measurement
Respiratory Examination
Cardiovascular Examination
High blood pressure develops slowly over the years, sometimes without any noticeable symptoms.
Severe high blood pressure causes organ damage in hypertensive emergencies.
Primary Hypertension
Secondary Hypertension
Middle-aged to elderly individuals with a family history of hypertension are affected and slight reduction can lower blood pressure.
First-line medications for hypertension includes ACE inhibitors/ARBs, calcium channel blockers, and thiazide diuretics.
Hypertension common in diabetic cases, it raises risk by 2.5 times in 5 years. Both conditions also increased risk of cardiovascular disease, stroke, and renal disease.
Physician aims to identify acute hypertension patients with end-organ damage symptoms needing urgent antihypertensive therapy. Initial therapy for acutely ill infants with severe hypertension is continuous IV infusions.
Therapy for renovascular hypertension aims to maintain normal blood pressure and prevent end-stage renal disease through various treatments.
Pseudo-hypertension may occur when high blood pressure is observed without actual organ damage, hypotensive symptoms from medications.
Surgical resection is preferred for pheochromocytoma as it cures hypertension. Preoperative alpha-adrenergic blockade with phenoxybenzamine is followed by beta-adrenergic blockade for tachycardia.
Cardiology, General
Patients should start walking, swimming, and cycling to improve heart condition under physician guidance.
Include healthy diet such as fruits, vegetables, whole grains, and avoid unhealthy food.
Psychological support is essential for managing stress, anxiety, and depression in heart patients. Use blood pressure measuring device and record blood pressure levels regularly.
Breathing exercises is effective to control blood pressure also yoga exercises help in hypertension. Lifestyle modification like intake of healthy nutritional supplements and proper hydration should be followed by patients.
Appointments with a cardiologist and preventing recurrence of disorder is an ongoing life-long effort.
Cardiology, General
Hydrochlorothiazide:
It is approved to manage hypertension alone or with other agents. It can be used in patients on ACE inhibitors.
Cardiology, General
Triamterene:
It raises potassium levels and use caution when combining with drugs that increase potassium.
Amiloride:
It is a potassium-conserving drug with mild effects compared to thiazide diuretics, that are used in hypertension and heart failure treatment.
Cardiology, General
Furosemide:
Inadequately controlled hypertensive patients with thiazides may not respond to furosemide.
Torsemide:
It can be used alone or with other antihypertensives. Take a dose of 5 mg daily, then increase up to 10 mg.
Cardiology, General
Captopril:
It inhibits angiotensin conversion, activates bradykinin, which regulates blood pressure effectively.
Ramipril:
It relaxes blood vessels has widen easier blood flow. This reduces strain on the heart and improves circulation efficiency.
Cardiology, General
Losartan:
It relaxes blood vessels and lowers blood pressure, which increases blood and oxygen to the heart.
Valsartan:
It blocks the RAAS system, which inhibits neprilysin causing angiotensin II accumulation from breakdown prevention.
Cardiology, General
Atenolol:
It treats angina, which improves survival post-heart attack, relaxes blood vessels, slows heart rate and reduces blood pressure.
Propranolol:
It competes with sympathomimetic neurotransmitters for non-selective beta receptor binding without preference for β1 or β2.
Cardiology, General
Hydralazine:
It reduces blood pressure through direct relaxation of vascular smooth muscle.
Minoxidil:
It is used for severe symptomatic hypertension with end-organ damage unresponsive to diuretic and antihypertensives.
Cardiology, General
Amlodipine:
It inhibits calcium ions during depolarization in smooth muscle and myocardium.
Verapamil:
It is a non-dihydropyridine antihypertensive that works on both vascular and cardiac systems, which acts as a vasodilator.
Eplerenone:
It blocks aldosterone at receptors, which lowers BP and sodium reabsorption.
Cardiology, General
Aliskiren:
It lowers plasma renin, that inhibits angiotensinogen conversion and disrupts renin-angiotensin-aldosterone system feedback loop.
Cardiology, General
Prazosin:
It blocks alpha1-receptors, that leads to peripheral vasodilation through vascular inhibition.
Doxazosin:
It inhibits alpha-adrenergic receptors, which causes vasodilation, decreased peripheral resistance, and lowered blood pressure.
Cardiology, General
Reserpine:
It depletes biogenic amines, that causes sympathetic dysfunction and reduced peripheral vascular resistance and lowers blood pressure.
Cardiology, General
Aprocitentan:
It is used to treat hypertension in adults not controlled on other antihypertensive drugs which lowers blood pressure.
Cardiology, General
Revascularization for renovascular hypertension with aortorenal bypass using saphenous vein graft or hypogastric artery.
Surgery is preferred for pheochromocytoma and aldosterone-producing adenoma to cure hypertension through tumor removal.
Angioplasty in fibromuscular dysplasia of renal artery has 60% to 80% hypertension resolution success.
Cardiology, General
In the diagnosis phase, evaluation includes detailed patient history of cardiovascular disorders, elevated blood pressure and associated symptoms.
In supportive care and management phase, patients should receive all the required attention in the form of postoperative care, monitoring, and rehabilitation.
Track blood pressure on daily basis and note medication side effects if occurs also start follow up with physician in every 1 to 2 months until blood pressure is controlled.
Pharmacologic therapy is very effective in the treatment as it includes first-line medications and combination therapy.
The regular follow-up visits with the cardiologist are schedule to check the improvement of patients along with treatment response.
Hypertension is a condition with consistently high force of blood against arteries. It is also called High blood pressure.
Blood pressure measured in mmHg, which consists of two numbers:
Systolic i.e., During heartbeat over Diastolic i.e., Between heartbeats pressure.
Normal blood pressure is generally noted as 120/80 mmHg.
Primary and secondary these are two types of hypertensions, and the risk factors include genetics, age and lifestyle.
High blood pressure key risk factor for heart issues, stroke, kidney disease, peripheral vascular problems.
Primary hypertension is the most common type, without a clear cause it affects 90% to95% of adults with hypertension while secondary hypertension shows 5% to 10% cases.
Hypertensive emergencies show target organ dysfunction, while hypertensive urgencies are situations without target organ dysfunction.
Hypertension is a global epidemic condition. In the US national health and nutrition examination survey data from 2011 to 2014 shows 86 million adults more than 20 years observed hypertension, which represents a 34% prevalence rate in the population.
Hypertension rates decreased in the early 2000s then again rises in 2014, with a noticeable increase among men in recent years.
Around 972 million people worldwide shows hypertension cases, with prevalence expected to increase up to 29% by 2025 in developing countries.
Black adults in the US and worldwide have high rates of hypertension. White adults may develop high BP later in their life and have lower average as compared to Black adults.
Primary hypertension has complex pathogenesis with multiple factors which affects blood pressure includes vascular reactivity, blood volume, and neural stimulation.
Primary hypertension progresses from occasional to established to complicated, that causes end-organ damage in the aorta, small arteries, heart, kidneys, and central nervous system as time passes.
Vascular changes cause increased systemic vascular resistance, and cardiac output stays slightly reduced with normal blood volume.
Hypertension caused due to environmental factors and complex gene inheritance along with genetic components.
DNA methylation and histone modification are linked with hypertension. High salt diets may cause nephron development due to methylation.
Mental stress initiates DNA methylase, increase autonomic response and methylation pattern predicts preeclampsia risk in pregnancy.
Rare genetic causes of hypertension include Liddle syndrome, glucocorticoid-remediable hyperaldosteronism, and deficiencies in alpha-hydroxylase enzymes.
Untreated hypertension worsens with age and increases mortality risk thus called as silent killer because it increases blood pressure.
Patients with resistant hypertension and comorbidities have higher risk for poor outcomes. Lower blood pressure may reduce risk for cardiovascular events.
Mortality from ischemic heart disease and stroke rises with higher blood pressure.
Outcome in hypertensive emergencies is influenced by initial organ damage and subsequent blood pressure control.
Hypertension increases risk of end-stage renal disease in Black patients even diabetic nephropathy patients with hypertension also at risk.
Hypertension occurs more in youth till age of 20 due to rising obesity and sedentary behaviors.
Hypertension increases significantly in individuals between 30 to 60 years old.
Blood Pressure Measurement
Respiratory Examination
Cardiovascular Examination
High blood pressure develops slowly over the years, sometimes without any noticeable symptoms.
Severe high blood pressure causes organ damage in hypertensive emergencies.
Primary Hypertension
Secondary Hypertension
Middle-aged to elderly individuals with a family history of hypertension are affected and slight reduction can lower blood pressure.
First-line medications for hypertension includes ACE inhibitors/ARBs, calcium channel blockers, and thiazide diuretics.
Hypertension common in diabetic cases, it raises risk by 2.5 times in 5 years. Both conditions also increased risk of cardiovascular disease, stroke, and renal disease.
Physician aims to identify acute hypertension patients with end-organ damage symptoms needing urgent antihypertensive therapy. Initial therapy for acutely ill infants with severe hypertension is continuous IV infusions.
Therapy for renovascular hypertension aims to maintain normal blood pressure and prevent end-stage renal disease through various treatments.
Pseudo-hypertension may occur when high blood pressure is observed without actual organ damage, hypotensive symptoms from medications.
Surgical resection is preferred for pheochromocytoma as it cures hypertension. Preoperative alpha-adrenergic blockade with phenoxybenzamine is followed by beta-adrenergic blockade for tachycardia.
Cardiology, General
Patients should start walking, swimming, and cycling to improve heart condition under physician guidance.
Include healthy diet such as fruits, vegetables, whole grains, and avoid unhealthy food.
Psychological support is essential for managing stress, anxiety, and depression in heart patients. Use blood pressure measuring device and record blood pressure levels regularly.
Breathing exercises is effective to control blood pressure also yoga exercises help in hypertension. Lifestyle modification like intake of healthy nutritional supplements and proper hydration should be followed by patients.
Appointments with a cardiologist and preventing recurrence of disorder is an ongoing life-long effort.
Cardiology, General
Hydrochlorothiazide:
It is approved to manage hypertension alone or with other agents. It can be used in patients on ACE inhibitors.
Cardiology, General
Triamterene:
It raises potassium levels and use caution when combining with drugs that increase potassium.
Amiloride:
It is a potassium-conserving drug with mild effects compared to thiazide diuretics, that are used in hypertension and heart failure treatment.
Cardiology, General
Furosemide:
Inadequately controlled hypertensive patients with thiazides may not respond to furosemide.
Torsemide:
It can be used alone or with other antihypertensives. Take a dose of 5 mg daily, then increase up to 10 mg.
Cardiology, General
Captopril:
It inhibits angiotensin conversion, activates bradykinin, which regulates blood pressure effectively.
Ramipril:
It relaxes blood vessels has widen easier blood flow. This reduces strain on the heart and improves circulation efficiency.
Cardiology, General
Losartan:
It relaxes blood vessels and lowers blood pressure, which increases blood and oxygen to the heart.
Valsartan:
It blocks the RAAS system, which inhibits neprilysin causing angiotensin II accumulation from breakdown prevention.
Cardiology, General
Atenolol:
It treats angina, which improves survival post-heart attack, relaxes blood vessels, slows heart rate and reduces blood pressure.
Propranolol:
It competes with sympathomimetic neurotransmitters for non-selective beta receptor binding without preference for β1 or β2.
Cardiology, General
Hydralazine:
It reduces blood pressure through direct relaxation of vascular smooth muscle.
Minoxidil:
It is used for severe symptomatic hypertension with end-organ damage unresponsive to diuretic and antihypertensives.
Cardiology, General
Amlodipine:
It inhibits calcium ions during depolarization in smooth muscle and myocardium.
Verapamil:
It is a non-dihydropyridine antihypertensive that works on both vascular and cardiac systems, which acts as a vasodilator.
Eplerenone:
It blocks aldosterone at receptors, which lowers BP and sodium reabsorption.
Cardiology, General
Aliskiren:
It lowers plasma renin, that inhibits angiotensinogen conversion and disrupts renin-angiotensin-aldosterone system feedback loop.
Cardiology, General
Prazosin:
It blocks alpha1-receptors, that leads to peripheral vasodilation through vascular inhibition.
Doxazosin:
It inhibits alpha-adrenergic receptors, which causes vasodilation, decreased peripheral resistance, and lowered blood pressure.
Cardiology, General
Reserpine:
It depletes biogenic amines, that causes sympathetic dysfunction and reduced peripheral vascular resistance and lowers blood pressure.
Cardiology, General
Aprocitentan:
It is used to treat hypertension in adults not controlled on other antihypertensive drugs which lowers blood pressure.
Cardiology, General
Revascularization for renovascular hypertension with aortorenal bypass using saphenous vein graft or hypogastric artery.
Surgery is preferred for pheochromocytoma and aldosterone-producing adenoma to cure hypertension through tumor removal.
Angioplasty in fibromuscular dysplasia of renal artery has 60% to 80% hypertension resolution success.
Cardiology, General
In the diagnosis phase, evaluation includes detailed patient history of cardiovascular disorders, elevated blood pressure and associated symptoms.
In supportive care and management phase, patients should receive all the required attention in the form of postoperative care, monitoring, and rehabilitation.
Track blood pressure on daily basis and note medication side effects if occurs also start follow up with physician in every 1 to 2 months until blood pressure is controlled.
Pharmacologic therapy is very effective in the treatment as it includes first-line medications and combination therapy.
The regular follow-up visits with the cardiologist are schedule to check the improvement of patients along with treatment response.
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