Hypertension

Aka: Hypertension, Htn, Essential Hypertension

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II. Epidemiology

  1. Demographics
    1. Overall Hypertension Prevalence: 30% of U.S. Adults
      1. Most common chronic condition followed by primary care physicians in the U.S.
      2. White Adults in US: 20% are hypertensive
      3. Black Adults in US: 30% are hypertensive
    2. Age 60-69 years old: 65% are hypertensive
      1. Of all hypertensives, >50% are over age 65 years
    3. Black patients (esp. women) are affected by Hypertension at least 30% more than white patients
      1. Decreased access to medical care is a key contributer to racial disparity
      2. https://www.acc.org/Latest-in-Cardiology/Articles/2020/04/06/08/53/Racial-Disparities-in-Hypertension-Prevalence-and-Management
  2. Outcomes
    1. Best predictor to outcome varies by age
      1. Diastolic Blood Pressure best predictor <50 years
      2. SBP and DBP predict outcomes equally ages 50-59
      3. Pulse Pressure best predictor age >60 years
    2. Coronary Artery Disease (and Myocardial Infarctions)
      1. Hypertension Causes 35-45% morbidity and mortality
    3. Cerebrovascular Accident
      1. Relative Risk increases 1.84 for each 10 mmHg DBP
      2. Midlife Hypertension raises longterm CVA risk
      3. Seshadri (2001) Arch Intern Med 161:2343-50 [PubMed]
    4. Other Cardiovascular Disease impacted by Hypertension (and reduced risk with Blood Pressure control)
      1. Congestive Heart Failure
      2. Chronic Kidney Disease
    5. Alzheimer's Disease
      1. Increased SBP in middle age is predisposing factor
    6. Reference
      1. (1995) Lancet 346(8991):1647-53 [PubMed]
      2. Kivipelto (2001) BMJ 322:1447-51 [PubMed]

III. Definitions

  1. See Hypertension Criteria

IV. Types

  1. Essential Hypertension (Primary Hypertension)
    1. See Hypertension Criteria
    2. Stage 1-2 (DBP 90-104) in 80% of cases
  2. Accelerated Malignant Hypertension
    1. Recent substantial Blood Pressure increase
    2. Associated with Retinal vessel damage
      1. Retinal Hemorrhages
      2. Retinal exudates
      3. Papilledema
    3. Diastolic Blood Pressure over 140 mmHg
  3. Isolated Systolic Hypertension
    1. Systolic Blood Pressure: >160 mmHg
    2. Diastolic Blood Pressure: <90 mmHg
    3. Risks
      1. Coronary Artery Disease
      2. Cerebrovascular Accident
    4. Onset: 5th decade
    5. Affects 11% of those over age 75 years
    6. Results from progressive fall in vessel compliance

V. Causes: Secondary Hypertension

  1. See Hypertension Causes
  2. Secondary Hypertension accounts for 5-10% of Hypertension Causes overall
    1. In age 18 to 40 years old, accounts for 30% of Hypertension

VI. Diagnosis

  1. See Hypertension Evaluation
  2. See Blood Pressure
  3. See Hypertension Criteria
  4. See Ambulatory Blood Pressure Monitoring
  5. See Home Blood Pressure Monitor
  6. Hypertension Screening
    1. Indicated in all adult patients age >18 years at office visits (USPTF 2021)

VII. Evaluation

  1. Hypertension Evaluation History
  2. Hypertension Evaluation Exam
  3. Hypertension Evaluation Labs

VIII. Management

  1. See Hypertension Management

IX. References

  1. Clarke (2023) Am Fam Physician 108(3): 352-9 [PubMed]

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