Hypertension Management

Introduction to Hypertension

Hypertension is the leading modifiable risk factor for cardiovascular disease, stroke, heart failure, kidney disease, and premature death globally, with most cases being asymptomatic, earning it the nickname "the silent killer" 1, 2, 3

African Americans develop hypertension at younger ages and present with higher rates of complications including stroke and end-stage kidney disease 3
Age >65 years, male sex, increased body weight/obesity, family history of hypertension or cardiovascular disease, diabetes mellitus, dyslipidemia, smoking, excessive alcohol consumption, physical inactivity, and psychosocial/socioeconomic stressors are risk factors for hypertension 4

Hypertension involves complex dysregulation of multiple organ systems including the kidneys, cardiovascular system, and central nervous system, along with hormonal networks, vascular mechanisms, and immune processes 1
Increased peripheral vascular resistance due to endothelial dysfunction, vasoreactivity changes, and vascular remodeling, sodium and water retention by the kidneys, sympathetic nervous system overactivity, and renin-angiotensin-aldosterone system activation contribute to hypertension 1

The American Heart Association recommends ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to confirm office readings and exclude white coat hypertension 6, 1
Initial diagnostic workup should include office blood pressure measurement, 12-lead ECG, basic metabolic panel, fasting lipid panel, fasting glucose or HbA1c, urinalysis with albumin-to-creatinine ratio, and thyroid-stimulating hormone (TSH) 4, 6

The European Society of Cardiology recommends first-line treatments including lifestyle modifications and pharmacologic treatment with thiazide or thiazide-like diuretics, ACE inhibitors, angiotensin receptor blockers (ARBs), or calcium channel blockers 1, 2
The American College of Cardiology recommends target blood pressure <130/80 mm Hg for most adults <65 years, and <130 mm Hg for adults ≥65 years 1, 3

Resistant hypertension increases risk of coronary disease, heart failure, stroke, end-stage renal disease, and all-cause mortality by 50% 6
Presence of hypertension-mediated organ damage (HMOD) significantly increases cardiovascular event risk 4