====== Essential hypertension ======

  * Also known as **idiopathic hypertension**
  * Idiopathic elevation of blood pressure (BP), which accounts for 95% hypertension diagnoses.

//Source: [[#references|Carretero 2000]]//

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===== Abbreviations =====

  * AHA = American Heart Association
  * BP = blood pressure, unit in mmHG
  * CKD = [[chronic kidney disease]]
  * DBP = diastolic blood pressure
  * HTN = [[hypertension]]
  * JNC = Joint National Committee
  * meds = medications
  * OSA = [[obstructive sleep apnea]]
  * SBP = systolic blood pressure
  * yo = years old

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===== Staging =====

^ Category ^ Systolic BP ^  ^ Diastolic BP ^
| Normal | < 120 |  and  | < 80 |
| Elevated | 120--129 |  and  | < 80 |
| Stage 1 HTN | 130--139 |  or  | 80--89 |
| Stage 2 HTN | > 140 |  or  | > 90 |

//Source: [[#references|AHA BP Readings]]//

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===== Differential Diagnosis =====

While most arterial hypertension has no clear causes, potential secondary causes should be ruled out:

  * **[[Chronic kidney disease]] (CKD)**
  * **Drug-induced hypertension:** intoxication, withdrawal, herbal supplements
  * **[[Obstructive sleep apnea]] (OSA)**
  * **[[Renal artery stenosis]]**
  * **[[White-coat hypertension]]**

//Source: [[#references|Iqbal 2019]]//

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===== Management =====

==== Lifestyle modification ====

  * Weight control
  * Salt restriction
  * Smoke secession
  * OSA management
  * Exercise

//Source: [[#references|Iqbal 2019]]//

==== Medications ====

JNC-8 guidelines from 2014 recommends to start meds for the following populations:

  * Patients with diabetes and CKD with BP > 140/90
  * 18--59 yo with SBP > 140
  * > 60 yo with BP > 150/90

=== Initial medications ===

  * [[Calcium channel blocker]] (CCB)
  * [[Angiotensin-converting-enzyme inhibitor]] (ACEI) or [[angiotensin II receptor blocker]] (ARB)
  * [[Thiazide diuretics]]

=== Disease specific ===

  * In CKD patients, start with ACEI/ARB


//Source: [[#references|Iqbal 2019]]//

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===== Related Topics =====

  * [[List of Antihypertensive Medications]]

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===== References =====

  * **//AHA BP Readings://** American Heart Association. [[https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings|Understanding Blood Pressure Readings]]. Last updated 2017-11-30 and retrieved on 2020-03-28.
  * **Carretero** OA, Oparil S. [[https://www.ahajournals.org/doi/10.1161/01.CIR.101.3.329|Essential Hypertension Part I: Definition and Etiology]]. Circulation. **2000**;101:329–335. DOI: [[https://doi.org/10.1161/01.CIR.101.3.329|10.1161/01.CIR.101.3.329]]
  * **Iqbal** AM, Jamal SF. [[https://www.ncbi.nlm.nih.gov/books/NBK539859/|Essential Hypertension]]. StatPearls. Last updated **2019**-12-01 and retrieved on 2020-03-28.

{{tag>Internal_medicine Cardiology Cardiovascular_disease Endocrinology Nephrology Conditions_and_diseases Article}}