Hypertension

Hypertension,

 or high blood pressure (BP), is an epidemic, contributing to nearly 13% of all deaths worldwide. It is the most common primary diagnosis in the United States. Hypertension is a major risk factor for stroke, myocardial infarction, heart failure, vascular disease, and chronic kidney disease. Owing to the associated morbidity and mortality, preventing and treating this condition is an important public health challenge.

At the first visit, BP should be obtained in both arms, with the arm that gives the highest reading used for subsequent readings

According to the 2017 ACC/AHA task force guidelines, BP should be recorded in both arms at the first visit. The arm that gives the higher reading should be used for subsequent readings. Repeated measurements should be separated by 1-2 minutes. Patients should avoid caffeine, exercise, and smoking for at least 30 minutes before BP measurement. They should be relaxed and sitting in a chair, with their feet on the floor and back supported, for more than 5 minutes. BP measurements made while the patient is sitting or lying on an examining table do not fulfill the criteria outlined. The guidelines suggest ensuring the cuff size is correct, such that the bladder encircles 80% of the arm. the most common cause of secondary hypertension?

Obstructive sleep apnea

Although the vast majority of patients have primary or essential hypertension, secondary hypertension is identified in approximately 10% of adult patients. Common causes of secondary hypertension include the following:

• Renovascular disease
• Obstructive sleep apnea
• Renal parenchymal disease
• Primary aldosteronism
• Drug- or alcohol-induced

Uncommon causes include the following:

• Pheochromocytoma/paraganglioma
• Cushing syndrome
• Hypothyroidism
• Hyperthyroidism
• Aortic coarctation
• Primary hyperparathyroidism
• Congenital adrenal hyperplasia
• Mineralocorticoid excess syndromes (other than primary aldosteronism)
• Acromegaly

 is recommended in the clinical evaluation and assessment of hypertension-mediated organ damage in patients with hypertension, according to 2018 guidelines from the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)

Funduscopy is routinely recommended in patients with hypertension who also have diabetes

According to guidelines from the ESC/ESH, funduscopy is recommended in patients with grades 2 or 3 hypertension and all patients with hypertension who have diabetes. It may also be considered in other patients with hypertension.

The guidelines also state that 12-lead ECG is recommended for all patients with hypertension. Echocardiography is recommended if ECG abnormalities or signs/symptoms of left ventricular (LV) dysfunction are present. It may also be considered when the detection of LV hypertrophy may influence treatment decisions.

The guidelines also recommend the measurement of serum creatinine, estimated glomerular filtration rate, and urine albumin/creatinine ratio in all patients with hypertension.

Ultrasound examination of the carotid arteries may be considered for the detection of asymptomatic atherosclerotic plaques or carotid stenosis in patients with documented vascular disease elsewhere.

Increased dietary potassium is recommended for adults with hypertension

Dietary potassium, calcium, and magnesium consumption have an inverse association with BP. Lower intake of these elements potentiates the effect of sodium on BP. Oral potassium supplementation may lower both systolic and diastolic BP. The ACC/AHA guidelines recommend potassium supplementation, preferably through dietary means, in adults with hypertension, unless contraindicated by the chronic kidney disease or the use of drugs that reduce potassium excretion.

Consumption of three or more drinks per day is associated with elevation of BP. ACC/AHA guidelines suggest that adult men and women with hypertension should be advised to drink no more than two and one standard drinks per day, respectively.

Even modest weight loss can lead to reduction in BP. Weight reduction may lower BP by 5-20 mm Hg per 10 kg of weight loss in a patient whose weight is more than 10% of ideal body weight.

Although coffee consumption in patients with hypertension is associated with short-term increases in BP, long-term coffee consumption is not associated with increased BP or cardiovascular disease. Some coffee consumption has been found to have cardiovascular benefits.

Women receiving medication for hypertension who become pregnant or are planning to become pregnant should be transitioned to methyldopa, nifedipine, and/or labetalol

According to ACC/AHA guidelines, women with hypertension who become pregnant, or are planning to become pregnant, should be transitioned to methyldopa, nifedipine, and/or labetalol. Women with hypertension who become pregnant should not be treated with ACE inhibitors, ARBs, or direct renin inhibitors. Lifestyle modifications are generally sufficient for the management of pregnant women with stage 1 hypertension who are at low risk for cardiovascular complications during pregnancy.

Simultaneous use of an ACE inhibitor, ARB, and/or renin inhibitor is possibly harmful and is not recommended among patients with hypertension. Beta-blockers are no longer considered first-line therapy for hypertension, but these agents can be used in cases with compelling indications aside from hypertension, such as systolic heart failure.

According to ACC/AHA guidelines, aldosterone antagonists are preferred agents in primary aldosteronism and resistant hypertension.

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