Cardiovascular Medicine Book

Information Resources


Hypertension Management

Aka: Hypertension Management
  1. See Also
    1. Hypertension
    2. Hypertension Causes
    3. Hypertension Evaluation
    4. Hypertension Evaluation History
    5. Evaluation Exam
    6. Hypertension Evaluation Labs
    7. Isolated Systolic Hypertension
    8. Hypertension Management
    9. Hypertension Risk Stratification
    10. Resistant Hypertension
    11. Antihypertensive Selection
    12. Hypertension Management for Specific Comorbid Diseases
    13. Hypertension Management for Specific Populations
    14. Hypertension Management for Specific Emergencies
    15. Hypertension in Children
    16. Hypertension in Infants
    17. Hypertension in Pregnancy
    18. Hypertension in Athletes
    19. Hypertension in the Elderly
  2. Management: General Guidelines
    1. See patients back at one month after starting agent
      1. Significantly improves compliance
      2. BP requires 1 month on agent to equilibrate
    2. Maximize compliance
      1. Work with patients to reduce adverse effects
      2. Switch to other agents if adverse effects significant
    3. Do not be overzealous
      1. Risk of overcorrection of Blood Pressure
      2. Avoid lowering diastolic pressure <70 mmHg
      3. Greater tolerance for elevated BP with increased age
        1. Study of 484 Swedish men over 70 from 1982-1992
        2. Risk if Diastolic Blood Pressure lowered below 90
          1. Increased cardiac event risk 3.9x
          2. Controlled for confounding factors
        3. Reference
          1. Merlo (1996) BMJ 313:457-61 [PubMed]
    4. Consider nighttime dosing
      1. Advantages
        1. Associated with decreased cardiovascular events and improve Blood Pressure control
          1. Hermida (2019) Eur Heart J +PMID:31641769 [PubMed]
        2. Benefit may best in patients who do not dip their Blood Pressure overnight
          1. Non-dippers: Older, Diabetes Mellitus, Chronic Kidney Disease, Resistant Hypertension
          2. Consider 24 hour ambulatory monitoring to define unclear cases
      2. Disadvantages
        1. Risk of non-compliance
          1. Do not switch to nighttime dose if patient can not remember that dose
        2. Risk of Orthostatic Hypotension and Fall Risk at night
      3. Indications to switch at least one medication to nighttime dosing
        1. Three or more antihypertensives used
        2. Best medications for nighttime dosing
          1. Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)
          2. Angiotensin Receptor Blockers
          3. Calcium Channel Blockers
          4. Alpha Blockers
          5. Beta Blockers
          6. Avoid Diuretics over night
      4. References
        1. (2012) Prescr Lett 19(1): 4
        2. Hermida (2011) J Am Soc Nephrol 22: 2313-21 [PubMed]
  3. Management: Choose agents with best outcome data
    1. Medications that prevent Hypertension vascular sequelae
      1. Diuretics
      2. ACE Inhibitors
      3. Calcium Channel Blockers
      4. Beta-Blockers
        1. Indicated in patients with known Coronary Artery Disease or chronic, stable Systolic Dysfunction
    2. Medications that prevent Left Ventricular Hypertrophy
      1. Most effective at reducing LVH risk
        1. ACE Inhibitors (e.g. Lisinopril)
        2. Diuretics (e.g. Chlorthalidone)
        3. Beta-Blockers (e.g. Metoprolol)
      2. Least effective at reduced LVH risk
        1. Prazosin
        2. Clonidine
        3. Diltiazem
      3. Reference
        1. Gottdiener (1997) Circulation 95:2007-14 [PubMed]
  4. Management: Protocol
    1. See Hypertension Risk Stratification
    2. See Hypertension Reduction Goal
  5. Management: Strategies
    1. Hypertension General Measures
    2. Antihypertensive Selection
    3. Hypertension Combination Therapy
    4. Hypertension Management for Specific Comorbid Diseases
    5. Hypertension Management for Specific Populations
    6. Hypertension Management for Specific Emergencies
  6. References
    1. (2000) Lancet 356:1955-64 [PubMed]

Hypertensive disease (C0020538)

Definition (MEDLINEPLUS)

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure.

Your blood pressure reading uses these two numbers, the systolic and diastolic pressures. Usually they are written one above or before the other. A reading of

  • 119/79 or lower is normal blood pressure
  • 140/90 or higher is high blood pressure
  • Between 120 and 139 for the top number, or between 80 and 89 for the bottom number is prehypertension

High blood pressure usually has no symptoms, but it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. You can control high blood pressure through healthy lifestyle habits and taking medicines, if needed.

NIH: National Heart, Lung, and Blood Institute

Definition (NCI_CDISC) Pathological increase in blood pressure defined as one of the following: History of hypertension diagnosed and treated with medication, diet, and/or exercise; On at least 2 separate occasions, documented blood pressure greater than 140 mm Hg systolic and/or 90 mm Hg diastolic in patients without diabetes or chronic kidney disease, or blood pressure greater than 130 mm Hg systolic or 80 mm Hg diastolic in patients with diabetes or chronic kidney disease; Currently on pharmacological therapy for the treatment of hypertension.
Definition (NCI) Blood pressure that is abnormally high.
Definition (NCI_CTCAE) A disorder characterized by a pathological increase in blood pressure; a repeatedly elevation in the blood pressure exceeding 140 over 90 mm Hg.
Definition (NCI_NCI-GLOSS) A blood pressure of 140/90 or higher. High blood pressure usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness.
Definition (CSP) persistantly high arterial blood pressure.
Definition (MSH) Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more.
Concepts Disease or Syndrome (T047)
MSH D006973
ICD9 997.91, 401-405.99
ICD10 I10-I15.9, I10, I10-I15
SnomedCT 38341003, 155302005, 194757006, 194760004, 155295004, 194756002, 266287006, 194794002, 195537001
LNC MTHU020789, LA14293-7, LA7444-8
English Hypertension, BLOOD PRESSURE HIGH, HYPERTENSION ARTERIAL, Hypertensive disease NOS, Hypertensive diseases, [X]Hypertensive diseases, Systemic hypertension, Hypertensive disorder, systemic arterial, hyperpiesia, hyperpiesis, systemic HTN, systemic hypertension (diagnosis), systemic hypertension, Hypertension arterial, Blood pressure high, HBP, HT, Hypertension NOS, Surg comp - hypertension, HTN, Hypertension [Disease/Finding], high blood pressure, hypertensive disorder, hypertensive vascular disease, arterial hypertension, arterial hypertension systemic, vascular hypertension, blood high pressure, high blood pressure disorder, systemic arterial hypertension, hypertensive disease, Hypertensive diseases (I10-I15), Complications affecting other specified body systems, not elsewhere classified, hypertension, High Blood Pressure, Hypertensive disease NOS (disorder), Hypertensive disease (disorder), (Hypertensive disease) or (hypertension), (Hypertensive disease) or (hypertension) (disorder), [X]Hypertensive diseases (disorder), hypertension, BLOOD PRESSURE, INCREASED, BLOOD PRESSURE, HIGH, Hypertensive Disorder, HIGH BLOOD PRESSURE, INCREASED BLOOD PRESSURE, HYPERTENSION, PRESSURE, HIGH BLOOD, High blood pressure, Hyperpiesia, Hyperpiesis, Hypertensive vascular degeneration, Hypertensive vascular disease, BP - High blood pressure, High blood pressure disorder, Systemic arterial hypertension, HBP - High blood pressure, BP+ - Hypertension, HT - Hypertension, Hypertensive disorder, systemic arterial (disorder), Hypertensive disorder, HTN - Hypertension, blood pressure; high, high; arterial tension, high; blood pressure, Hypertension, NOS, Hypertensive disease, NOS, Raised blood pressure (disorder), Blood Pressure, High, Blood Pressures, High, High Blood Pressures, Vascular Hypertensive Disorder, Hypertensive disease, HYPERTENSIVE DISEASE
French HYPERTENSION ARTERIELLE, Pression artérielle élevée, PAH, Hypertension SAI, TH, HYPERTENSION, TENSION ARTERIELLE E, Hypertension chronique, Hypertension permanente, Hypertension artérielle, Hypertension
Portuguese HIPERTENSAO, Hipertensão arterial NE, Hipertensão arterial, Pressão arterial alta, HYPERTENSAO ARTERIAL, PRESSAO SANGUINEA ELEVADA, Pressão Arterial Alta, Pressão Sanguínea Alta, Hipertensão
Spanish HIPERTENSION, PRESION SANGUINEA ALTA, Presión sanguínea alta, HTA, Hipertensión NEOM, Hipertensión arterial, HT, HIPERTENSION ARTERIAL, enfermedad hipertensiva, SAI, [X]enfermedades hipertensivas (trastorno), enfermedad hipertensiva, SAI (trastorno), [X]enfermedades hipertensivas, Hypertensive disease NOS, degeneración vascular hipertensiva, enfermedad hipertensiva, enfermedad vascular hipertensiva, hiperpiesia, hiperpiesis, hipertensión arterial (trastorno), hipertensión arterial, presión arterial alta, tensión arterial alta, tensión arterial elevada, Hipertensión, Presión Sanguínea Alta
German HYPERTONIE, Hypertonie, arteriell, Blutdruck, hoch, HBP, HT, Hypertonie NNB, BLUTDRUCK HOCH, HYPERTONIE ARTERIELL, Hypertension, Hypertonie
Dutch hypertensie NAO, hoge bloeddruk, arteriële hypertensie, bloeddruk; hoog, hoog; arteriële druk, hoog; bloeddruk, hypertensie, Bloeddruk, hoge, Hypertensie
Italian Ipertensione (HT), Ipertensione NAS, Pressione del sangue elevata, Ipertensione, Pressione sanguigna alta, Ipertensione arteriosa
Japanese 動脈性高血圧, 高血圧NOS, コウケツアツ, コウケツアツNOS, ドウミャクセイコウケツアツ, 高血圧, 高血圧症
Swedish Högt blodtryck
Czech hypertenze, Arteriální hypertenze, Vysoký krevní tlak, Hypertenze NOS, Hypertenze, vysoký krevní tlak, hypertonie
Finnish Kohonnut verenpaine
Polish Nadciśnienie
Hungarian Arteriás hypertonia, Hypertensio, HT, RR magas, Hypertonia k.m.n., Magas vérnyomás
Norwegian Høyt blodtrykk, Hypertensjon, Hypertoni
Derived from the NIH UMLS (Unified Medical Language System)

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