Hypertension Review

Hypertension Review

  • American Heart Association defines Hypertension as blood pressure of 140/90 or greater in adults 18 years & older.
  • Pre-Hypertension is when the blood pressure is greater than 130/90 but below 140/90
  • Normal blood pressure is < 120 mmHg systolic & < 80 mmHg diastolic in adults
  • Hypertension is the most common primary diagnosis in the United States
  • Hypertension is usually asymptomatic until there is significant damage to organs or tissues
  • Hypertension can happen with fear, anger, pain & stress as a result of stimulation of the sympathetic nervous system
  • Hypertension increases the risk of stroke, angina, myocardial infarction, heart failure, renal failure & retinopathy
  • Most people have Primary Hypertension. Primary Hypertension has no known cause & it may be genetic.
  • Some causes linked to primary HTN: elevated peripheral resistance, endothelial dysfunction, elevated lipids,
  • Hyperinsulinemia (insulin insensitivity), sympathetic nervous system disorder caused by insensitivity of baroreflexes, & dysfunction of the renin-angiotensin system

Factors controlling blood pressure are:

  • Cardiac output
  • Vascular resistance
  • Volume
  • Viscosity
  • Elasticity of arterial walls
  • Primary Hypertension (Essential or Idiopahic Hypertension)


Modifiable risk factors for Primary Hypertension

  • Obesity
  • Sedentary Lifestyle
  • Metabolic Syndrome
  • Dietary Factors (Increase fat, sodium, low potassium & calcium)
  • Smoking
  • Elevated blood sugars
  • Elevated total cholesterol
  • Elevated triglycerides
  • Decrease in HDL (good cholesterol)
  • Elevated LDL (bad cholesterol)


Non-Modifiable Risk Factors for Primary Hypertension

  • Increasing Age
  • Family History
  • Gender
  • Ethnicity
    ****The treatment for Primary Hypertension includes lifestyle modifications & drug therapy****


Primary Hypertension

  • Used to be termed “essential” HTN
  • Elevated B/P without a cause
  • Most patients have primary HTN


Secondary Hypertension

  • Hypertension that is caused by a systemic disease process that raises peripheral vascular resistance (hypertension that has a specific identifiable cause)
  • Hypertension in infants & children is usually Secondary Hypertension
  • In children younger than 6 years of age, the most common cause of Secondary Hypertension are renal disorders or coarctation of the aorta
  • Some examples of Secondary Hypertension are: Diabetes, tumors, Renal artery stenosis, Renal failure, Glomerulonephritis, Hyperthyroidism, Cushing disease, Guillain Barre Syndrome, Increased
  • intracranial pressure, COPD, sleep apnea, pregnacy.
    Isolated Systolic Hypertension
  • Elevated systolic blood pressure caused by increases in cardiac output, total peripheral vascular resistance or both.

Isolated Systolic Hypertension (ISH)

  • Elevated systolic with normal diastolic
  • Due to reduced vascular compromise in large arteries
  • A predictor of CV problems in the elderly
  • Fluid overload can cause ISH


Complicated Hypertension (Chronic Hypertension)

  • Complicated Hypertension is chronic hypertension that causes damage to the walls of blood vessels.
  • The smooth muscle cells of the arteries undergo hypertrophy & fibrosis develops in the tunica intima & media
  • Malignant Hypertension
  • Hypertension that happens rapidly
  • Diastolic pressure is > 140 mmHg


Malignant hypertension  

  • A medical emergency
  • Some causes of Malignant Hypertension are: Autonomic dysreflexia (spinal cord injuries), withdrawal of Beta Blockers, ETOH & some medications (cocaine, sympathomimetic agents, caffeine, licorice & more)
  • Malignant Hypertension has 2 subgroups: Hypertensive Emergency & Hypertensive Urgency. In both Hypertensive Emergency & Hypertensive Urgency, the diastolic blood pressure is usually > 120mm Hg
  • Hypertensive Emergency- characterized by sudden increase in either or both systolic & diastolic pressures with evidence of acute organ damage
  • Hypertensive Urgency- similar blood pressure elevations but without end organ damage


White-Coat Hypertension

  • White Coat Hypertension is blood pressure readings that are higher in the doctors office than at home
  • May signal that the patient is at risk for developing hypertension & will need further evaluation