Snapshot A 45-year-old African American man presents to his primary care physician for an annual wellness exam. He reports to feeling well and has no acute concerns. Medical history is unremarkable. He occasionally drinks a glass of wine every few days and does not smoke cigarettes. He exercises regularly and tries to maintain a healthy diet by incorporating more fruits, vegetables, and lean proteins. Physical examination is significant for a blood pressure of 155/105 mmHg. In his next two consecutive office visits, his blood pressures are 150/100 mmHg and 146/96 mmHg. He is started on hydrochlorothiazide. Introduction Clinical definition a sustained increased systemic arterial pressure typically defined as a login to view 2 more bullets Epidemiology risk age login to view 1 more bullet race family history physical inactivity obesity excessive alcohol use high-sodium diet Etiology primary (essential) hypertension (accounts for ~95% of cases) idiopathic secondary hypertension renal disease (e.g., fibromuscular dysplasia and renal artery stenosis) pregnancy (e.g., eclampsia) obstructive sleep apnea hyperaldosteronism thyroid disease Pathogenesis background blood pressure is the product of cardiac output and peripheral vascular resistance (BP = CO X SVR) login to view 5 more bullets the kidneys, heart, and adrenal glands work together to regulate vascular tone and blood volume login to view 6 more bullets pathology essential hypertension login to view 1 more bullet secondary hypertension login to view 3 more bullets Prognosis ↑ risk of stroke and cardiovascular disease Presentation Symptoms asymptomatic most patients are not aware they have hypertension Studies Blood pressure measurements the diagnosis should be based on ≥ 2 blood pressure readings in ≥ 2 visits Pathophysiological changes decreased diastolic filling normal ejection fraction increased renin production Treatment Managment approach in secondary hypertension, it is important to address the underlying problem certain antihypertensive medications are indicated if it addresses a comorbid condition Conservative weight loss indication login to view 1 more bullet exercise indication login to view 1 more bullet dietary modifications indication login to view 1 more bullet Medical first-line treatment options in patients without a specific indication for a particular agent that would address a comorbid condition thiazide diuretics angiotensin-converting enzyme inhibitors login to view 1 more bullet angiotensin receptor blockers long-acting calcium channel blocker login to view 1 more bullet Complications Ischemic or hemorrhagic stroke and transient ischemic attacks Left ventricular hypertrophy Heart failure Chronic kidney disease Visual disturbances (e.g., retinal hemorrhages and exudates) Peripheral vascular disease Aortic dissection Aortic aneurysm