Description

• Hypertension (HTN) is defined as ≥2 elevated BPs (systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg) at ≥2 visits; operationally, any BP at which drug treatment results in a net benefit to a population.
• HTN is a strong risk factor for cardiovascular disease.
• Pre-HTN: Systolic BP = 120–139 mm Hg or diastolic BP = 80–89 mm Hg
• Synonym(s): Benign, Chronic, Idiopathic, Familial, or Genetic HTN; High BP

• Isolated systolic HTN is common.
• Therapy has been shown to be effective and beneficial at preventing stroke, although target systolic BP is higher than in younger patients (around 150 mm Hg systolic), and adverse reactions to medications are more frequent. The benefit of therapy has been conclusively demonstrated in older patients (1).

Pediatric Considerations
Measure BP during routine exams.

• Elevated BP during pregnancy may be either chronic HTN or pregnancy-induced preeclampsia. ACE inhibitors and angiotensin II receptor blockers (ARBs) are contraindicated.
• Maternal and fetal mortality benefit from treatment of severe HTN. Evidence not clear for mild HTN (see topic “Preeclampsia”).

Epidemiology

• Lifetime risk for men and women aged 55–65 years by age 80–85 is >90%.
• Predominant age: Essential (primary, benign, idiopathic) onset usually in the 20s–30s.
• Predominant sex: Male > Female; males tend to run higher than females and have a significantly higher risk of cardiovascular disease at any given pressure.

Prevalence
50 million (1988–1991 NHANES III); 20% of the US population

Risk Factors

Family history, obesity, alcohol use, excess dietary sodium, stress, and physical inactivity

Genetics
BP levels are strongly familial, but no clear genetic pattern exists. Familial risk for cardiovascular diseases should be considered.

Etiology

• >90% of HTN has no identified cause.
• Secondary causes of HTN: see topic “Hypertension, Secondary and Resistant”: Renal parenchymal: Glomerulonephritis, pyelonephritis, polycystic kidneys; Endocrine: Primary hyperaldosteronism, pheochromocytoma, hyperthyroidism, Cushing syndrome; Vascular: Coarctation of the aorta, renal artery stenosis; Chemical: Oral contraceptives, NSAIDs, decongestants, antidepressants, sympathomimetics, many industrial chemicals, corticosteroids, ergotamine alkaloids, lithium, cyclosporine, lead. Sleep apnea