Hypertension

Abstract

Hypertension affects almost 1.4 billion people worldwide, making it one of the leading preventable causes of death. It is a potent risk factor for atherosclerotic cardiovascular disease and associated with microvascular complications. Effective blood pressure management has shown to decrease the incidence of stroke, heart attacks, and heart failure. Hypertension is defined as systolic blood pressure (SBP) ≥130 mm Hg or diastolic blood pressure (DBP) ≥80 mm Hg. Based on etiology, whether unknown or known, hypertension can be classified as primary or secondary, respectively. Management of hypertension must include non-pharmacological and pharmacological interventions. Non-pharmacological interventions include weight loss, DASH (Dietary Approaches to Stop Hypertension) diet, sodium reduction, potassium supplementation, increased physical activity, smoking cessation, and reduction in alcohol consumption. Pharmacological first-line agents for initiation of antihypertensive therapy include but are not limited to thiazide diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme (ACE) inhibitor, or angiotensin receptor blockers (ARBs). The choice of one over the other is guided by patients’ comorbidities such as chronic kidney disease, diabetes, heart failure, albuminuria, and race. The outpatient management of hypertension is an essential part of the care provided by any internist, primary care specialist, or internal medicine subspecialist. Hypertensive crises are sudden, severe elevation in blood pressure >180/110 mm Hg, with or without associated target-organ dysfunction. Management of hypertensive emergencies requires parenteral antihypertensive therapy and intensive care unit monitoring.