Hypertension Guide: Causes, Diagnosis & Treatments

Hypertion Overview

Hypertension affects a large population of people in the world today. According to WHO An estimated 1.28 billion adults between the ages of 30 to 79 have hypertension, most (two-thirds) living in low- and middle-income countries.

in adults an estimated 46% are unaware that they even have the condition. That’s means It affects approximately one in three adults.

 

What does this mean?

As a Doctor, Nurse or Pharmacist you will a lot of patients that have this condition and it is very important that you have a good grasp on the topic to better help your patients.

This means familiarizing yourself with what hypertension is, the types of hypertensions, the causes of hypertension, the symptoms, some risk factors, medication and treatment as well as some dos and don’ts as related to hypertension.

 

What is Hypertension?

Hypertension also called high blood pressure  (HBP) is a sustained systolic blood pressure of greater than or equal to 140 mm Hg or a sustained diastolic blood pressure of greater than or equal to 90 mm Hg  measured on more than one occasion when the patient is at rest.

 To confirm that a patient has Hypertensions there are two diagnostics criteria to use:

• The 2017 ACC/AHA guidelines: ≥130/80 mm Hg

 

 

 

• The JNC 8 guidelines: ≥140/90 mm Hg

 

Types of Hypertensions

There are two major types of hypertensions and this classification is based on origin/cause

• Primary (essential) hypertension (~90% of cases): No identifiable cause or unknown origin.
• Secondary hypertension: Caused by an underlying disease condition (e.g., kidney disease, diabetes, vascular anomalies like coarctation of the aorta).

 

 

Risk factors for hypertension

 

Risk factors i.e things that can increase the chances of a patient getting hypertension can be classified into Non-Modifiable Risk Factors and Modifiable Risk Factors

 

Non-Modifiable Risk Factors

These are things that are out of personal control examples include:

• Age:The risk of high blood pressure increases with age. 
• Family History:A family history of hypertension increases the likelihood of developing the condition. 
• Ethnicity/Race:Black individuals are at higher risk of developing hypertension
• Gender: men are more likely to develop hypertension before age 65 and women are more likely to develop it after age 65.

Modifiable Risk Factors

Obesity and Overweight: Excess weight puts stress on the heart and blood vessels, increasing blood pressure.

• Lack of Physical Activity: Sedentary lifestyles are associated with higher blood pressure.
• Unhealthy Diet: A diet high in sodium and low in potassium can increase blood pressure.
• Excessive Alcohol Consumption: High alcohol intake raises blood pressure.
• Smoking: Smoking damages blood vessels and immediately raises blood pressure.
• Stress: Chronic stress can contribute to hypertension
• Other Medical Conditions: Certain medical conditions like kidney disease, metabolic syndrome, sleep apnea, and thyroid problems can also increase the risk of hypertension.

 

 

Signs and Symptoms of Hypertension

Majority of people with high blood pressure have no symptoms, even at dangerously high blood pressures levels. Hypertension can be present for years without showing any symptoms.

A few people with high blood pressure may have:

• severe headaches
• chest pain
• dizziness
• difficulty breathing
• nausea
• vomiting
• blurred vision or other vision changes
• anxiety
• confusion
• buzzing in the ears
• nosebleeds
• abnormal heart rhythm

However, these symptoms aren’t specific. They usually don’t occur until high blood pressure has reached a severe or life-threatening stage.

 

Diagnosis of Hypertension

1. Screening

• Annual screening for:
  • Adults > 40 years
  • Adults with risk factors (e.g., obesity, diabetes, kidney disease)
• Every 3–5 years for:
  • Adults 18–39 years with normal BP and no risk factors
• Method: In-office blood pressure measurement
  • Elevated BP should be confirmed with two readings on two separate visits, using both arms

2. Diagnostic Confirmation

• Out-of-office BP measurement is essential before starting treatment:
  • Ambulatory Blood Pressure Monitoring (ABPM): 24-hour monitoring, preferred method
  • Home Blood Pressure Monitoring (HBPM): Patient takes BP readings at different times over several days

3. Initial Evaluation

• History and Physical Exam:
  • Assess cardiovascular risk and possible secondary causes
  • BMI, waist circumference, cardiac and neurologic exams
• Laboratory and Diagnostic Workup:
  • Basic tests:
    • Fasting glucose
    • Serum electrolytes: sodium, potassium, calcium
    • Creatinine, eGFR
    • Lipid profile
    • CBC, TSH
    • Urinalysis, urine albumin-to-creatinine ratio
    • ECG
  • Additional tests (based on risk or findings):
    • Hemoglobin A1c
    • Fundoscopy (retinopathy)
    • Liver function tests
    • Serum uric acid
    • Echocardiogram (if LVH or secondary cause suspected)

Treatment of Hypertension

Goal of treatment is to bring patient blood pressure <130/80 mm Hg

This can be achieved by:

• • Non-pharmacologic/Lifestyle changes
  • Pharmacologic therapy

 

Nonpharmacologic Measures (Lifestyle Changes) SBP >120 mm Hg or DBP >80 mm Hg

Intervention	Target	Expected SBP Reduction
Weight loss	Get patient to Ideal body weight	↓ ~1 mm Hg per kg lost
DASH diet	Rich in fruits, vegetables, whole grains; low fat	↓ ~11 mm Hg
Sodium reduction	<1500 mg/day	↓ 5–6 mm Hg
Potassium intake	3.5–5 g/day (via diet)	↓ 4–5 mm Hg
Aerobic exercise	90–150 min/week	↓ 5–8 mm Hg
Alcohol moderation	≤2 drinks/day (men), ≤1 (women)	↓ 4 mm Hg

 

Pharmacologic Treatment

This is used when patients have the following:

• SBP ≥130 or DBP ≥80 with:
  • ASCVD or risk ≥10%
  • Diabetes, CKD, or age ≥65
• SBP ≥140 or DBP ≥90 in all patients

 

First-line Medications

• ACE inhibitors (e.g., lisinopril): preferred in diabetes, CKD with albuminuria
• ARBs (e.g., losartan): alternative to ACEIs
• Thiazide diuretics (e.g., chlorthalidone): effective, especially in Black patients
• Calcium channel blockers (CCBs, e.g., amlodipine)

In Black adults without heart failure or CKD, thiazides or CCBs are recommended first.

Initial Strategy

• Stage 1 HTN (130–139/80–89 mm Hg): start monotherapy
• Stage 2 HTN (≥140/90 mm Hg): start combination therapy (e.g., ACEI + CCB or diuretic)

Second-line Options

• Beta blockers: for patients with CAD, heart failure, atrial fibrillation
• Aldosterone antagonists: for resistant hypertension or primary hyperaldosteronism
• Loop diuretics: for GFR <30 mL/min or volume overload
• Alpha-blockers, alpha-2 agonists, vasodilators: rarely used or for special indications

 

Treatment by Comorbidities

Condition	Preferred Agents
Diabetes	ACEI or ARB (especially if albuminuria)
CKD	ACEI or ARB
Heart failure (HFrEF)	Beta blockers (e.g., carvedilol), ACEI/ARB, diuretics
Ischemic heart disease	ACEI/ARB + beta blocker
Stroke/TIA	Thiazide + ACEI/ARB
Asthma	Avoid beta blockers; prefer ARBs, thiazides, or CCBs
Gout	Avoid thiazides; prefer ARB (e.g., losartan), ACEI, CCB
Osteoporosis	Thiazide diuretics
Migraine	Beta blockers or CCBs

 

Follow-Up & Titration

• 1 month after starting meds: assess BP and labs
• Adjust based on:
  • Adverse effects (e.g., switch ACEI to ARB for cough)
  • Therapeutic targets: increase dose, switch class, or add second/third agent
  • Medication adherence and access

Outcomes of Hypertension

If left untreated or unmanaged persistent high blood pressure can lead to some severe outcomes like:

• Heart Attack
• Stroke
• Heart Failure
• Coronary Artery Disease
• Arrhythmias
• Other Organ Damage
• Kidney Disease
• Vision Loss

 

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