Hypertension

Hypertension is defined as a systole BP > 140 mmHg and/or a diastolic BP > 90 mmHg based on three measurements, each separated by two weeks. It is classified as Stage 1 Hypertension and Stage 2 Hypertension.

Stage 1 (essential) Hypertension

It represent 95% of hypertension cases. Systolic BP 140-139 mmHg, Diastolic BP 90-99 mmHg. Risk factors: family history of hypertension or heart disease, high-sodium diet, smoking, obesity, race (African-American > Caucasians), elderly

Signs and Symptoms:

• Asymptomatic until complications develop
  
• Retinal changes
• S4 gallop
• Systolic click
• Loud S2
• If untreated will damage to the heart, brain, kidney, vasculature, and eye

Treatments:

• Lifestyle management
• Diuretics and beta-blocker
• Test for end-organ complication periodically; renal and cardiac complications

Stage 2 Hypertension

Stage 2 hypertension is due to an identifiable organic cause. Systolic BP is > 160 mmHg and diastolic BP is > 100 mmHg.

Etiologies and Treatments:
Treatments for stage 2 hypertension are treatment of underlying causes:

• Renal disease (stage 1); treatments: ACEIs
• Renal artery stenosis; treatments: angioplasty and stenting, ACEIs, and open surgery
• OCP use; treatment: discontinue OCPs
• Pheochromocytoma; treatment: surgical removal of tumor
• Conn's syndrome (hyperaldosteronism); treatment: surgical removal of tumor
• Cushing's syndrome; treatment: surgical removal of tumor
• Coarctation of the aorta; treatment: surgical repair