cardiovascular disorders
Hypertension
Introduction
Hypertension is sustained elevation of resting systolic blood pressure (≥130 mm Hg), diastolic blood pressure (≥80 mm Hg), or both. Hypertension with no known cause (primary; formerly, essential, hypertension) is most common. Hypertension with an identified cause (secondary hypertension) is usually due to primary aldosteronism. Sleep apnea, chronic kidney disease, obesity, or renal artery stenosis are other causes of secondary hypertension. Usually, no symptoms develop unless hypertension is severe or long-standing. Diagnosis is by sphygmomanometry. Tests may be done to determine cause, assess organ damage, and identify other cardiovascular risk factors. Treatment involves lifestyle changes and medications, including diuretics, angiotensin-converting enzyme (ACE) inhibitors,angiotensin IIreceptor blockers, and calcium channel blockers. 80 mm Hg or taking medication for hypertension. Nearly half of adults in the United States have hypertension. Many of these people are not aware that they have hypertension. About 80% of adults with hypertension have been recommended treatment with medication and lifestyle modification, but only about 50% with hypertension receive treatment ( General references ). 140/90 mm Hg ( General references ). High blood pressure is more common in non-Hispanic Black adults (58%) than in non-Hispanic White adults (49%), non-Hispanic Asian adults (45%), or Hispanic adults (39%— General references ). Among those recommended to take blood pressure medication and make lifestyle modifications, blood pressure control is higher among non-Hispanic White adults (31%) than in non-Hispanic Black adults (20%), non-Hispanic Asian adults (24%), or Hispanic adults (23%— 65 years have hypertension, and people with a normal BP at age 55 have a 90% lifetime risk of developing hypertension ( General references ). Because hypertension becomes so common with age, the age-related increase in BP may seem innocuous, but higher BP increases morbidity and mortality risk. Hypertension during pregnancy has special considerations because complications are different; hypertension that develops during pregnancy may resolve after pregnancy (see Hypertension in Pregnancy and Categories of BP in adults defined by the American College of Cardiology/American Heart Association (ACC/AHA) include normal, elevated BP, stage 1 (mild) or stage 2 hypertension ( General references ) (see table Hypertension is defined as resistant when BP remains above goal despite use of 3 different antihypertensive medications at maximally tolerated doses. Patients with resistant hypertension have higher cardiovascular morbidity and mortality ( General references ). 