Approach To Hypertension

Definitions

Essential hypertension: Also known as idiopathic or primary hypertension. It has no known cause, yet it comprises approximately 95% of all cases of hypertension. Lifestyle modification: A cornerstone in the treatment of hypertension, consisting of regular aerobic activity, weight loss, decreased salt intake, and increased intake of fruit and vegetables, while decreasing the amount of total fat. especially saturated fat, in the diet. Alcohol consumption should be moderated, no more than two glasses of wine per day for men and one glass per day for women. Prehypertension: Blood pressures 120-139/80-89 mmHg Stage I hypertension: Blood pressures 140-159/90-99 mmHg Stage II hypertension: Blood pressures >160/100 mmHg Secondary hypertension: Elevated arterial blood pressure with a known underlying cause, such as renal artery stenosis or primary aldosteronism. Prevalence is approximately 5-6% of all cases of hypertension.

Clinical Approach Initial Evaluation and Management

Hypertension can first be staged, to guide the intensity of medical intervention, by measuring blood pressures on two or more occasions. Underlying causes of hypertension must then be considered. Essential or idiopathic hypertension is the most common form of hypertension, comprising 92-95% of cases, but approximately 5-7% of cases of hypertension are caused by secondary causes (Table 9-1). To identify the secondary (and potentially reversible) causes of hypertension, the clinician must be aware of the clinical and laboratory manifestations of the processes. A secondary cause of hypertension, and thus more extensive testing, is indicated when patients have any of the following clinical features: age of onset before 25 years or after 55 years, presenting with malignant hypertension, requiring three or more antihypertensive medications, hypertension that has suddenly become uncontrolled, a rising creatinine level with the use of angiotensin-converting enzyme (ACE) inhibitors, or overt clinical signs of a secondary cause (Table 9-2).

Other Cardiac Risk Factors and Evaluation for Target Organ Damage

Cardiac risk evaluation and treatment are extremely important to establishing the prognosis, identifying organ dysfunction, and dictating therapy. Cardiovascular risk factors and hypertensive target organ damage should be identified The major risk factors of cardiovascular disease are age, cigarette

Table 9-1

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