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Systemic hypertension (HTN) means high
blood pressure. The blood pressure is characterized by two values. The highest value
(systolic blood pressure) is the maximum value the pressure can reach in the arteries
because of the contraction of the heart. The lowest value (diastolic blood pressure) is
the value obtained after heart contraction. A patient is said to be hypertensive when the
systolic blood pressure is higher than 140 mm Hg and/or the diastolic blood pressure is
higher than 90 mm Hg.
Risk Factors
Risk factors for developing HTN include obesity, ethanol abuse, a family history of HTN,
African-American heritage, type II diabetes mellitus, low socioeconomic status, and
increasing age.
Complications
It is not normal for blood pressure (BP) to increase with age in adults. However, the
absolute health risks from HTN increase with age. The most common problems that can
develop because of HTN are coronary artery disease, heart attack (HA), stroke or
cerebrovascular accident (CVA), heart failure, renal disease, and death. Control of HTN
reduces the incidence of CVA and HA and prolongs life.
Diagnosis
1. Routine BP measurements should be taken with the patient seated, after at least 5
minutes of rest, with the arm supported at the level of the heart.
2. Home BP measurements are typically about 5–10 mm Hg lower than those taken in the
medical office. Therefore, BP should be measured in several sittings by the doctor before
the diagnosis can be made.
Physical Examination
A. In some cases, high BP has a cause. To detect this cause, if any, a history and
physical examination, followed by a few well-chosen tests, should be done. Although
lifestyle factors, such as alcohol abuse and obesity, may make HTN worse, few patients
only have a direct cause of the increased blood pressure. Causes of the high BP to
consider include alcohol or drug abuse, pregnancy, renal artery stenosis (narrowing of the
artery which supplies the kidney with blood and oxygen), thyroid disease, kidney disease,
panic disorder, endocrine disorders, and medication effects. Unless the history and
physical examination suggest otherwise, diagnostic laboratory testing can be limited to
the following: serum electrolytes, glucose, kidney function, complete blood count, and
urinalysis.
B. Assessment of organ damage due to HTN
The presence of organ damage increases the clinical risk due to HTN. Typical
manifestations of this organ damage due to HTN includes thickening of the walls of the
heart, coronary artery disease, retinal (eye) disease, heart failure, kidney disease, and
CVA. Symptomatic of this organ damage can usually be detected through the history and
physical examination. In addition to laboratory tests, an electrocardiogram, a chest
X-ray, and a urine analysis should be performed.
C. Assessment of other cardiovascular risk factors is necessary for a comprehensive and
safe approach to the treatment of HTN. The presence of other cardiovascular risk factors
(i.e., hyperlipidemia or smoking) increases the importance of controlling HTN as one part
of comprehensive risk reduction. In addition to history and physical examination,
laboratory screening for hyperlipidemia (and diabetes in patients at high risk) is
indicated. Control of all modifiable cardiovascular risk factors should be stressed.
Treatment
1. Low-sodium diet: Limiting dietary sodium to less than 2 g/day is recommended. Patients
should be taught to use food labels and to make healthy choices in restaurants.
2. Weight loss: Patients who are at least 10% above ideal body weight should be instructed
on a regimen of diet and exercise that can be sustained indefinitely.
3. Moderation of alcohol to less than two standard drinks per day is recommended.
4. Exercise: Regular exercise lowers BP and overall cardiovascular risk independently of
weight loss.
5. Pharmacologic treatment: Typical medications employed are diuretics (to increase
urination), beta-blockers, calcium channel blockers, ACE inhibitors, etc.
6. Control of other cardiovascular risk factors should also be carried out.
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