Hypertension

1. Etiology: Essential or Primary hypterension does not have a cause of a set of causes. "Essential hypertension, which does not have a single identifiable cause, represents the vast majority of cases (85–95%)" (Moiz et. al, 2024) "Approximately 95% of cases of hypertension have no known cause and therefore are diagnosed as primary hypertension (also commonly called essential hypertension)." (McClance and Heuther, 2019)

2. Impact on other body systems/complications: "Evidence of heart disease, renal insufficiency, central nervous system dysfunction, impaired vision, impaired mobility, vascular occlusion, or edema can all be caused by sustained hypertension."(McClance and Heuther, 2019)

3. Treatment: "Out-of-office BP measurements include home BP monitoring (HBPM) which is now very commonly used" among hypertensive patients [22]. HBPM has been shown to improve patient motivation for self-care as well as to help patients increase their adherence to antihypertensive medications [23]. " (Moiz et. al, 2024)

3.1. Treatment Options: Lifestyle modifications such as healthy diet, limiting sodium intake, regular excercise, quitting smoking cigarettes, moderate alcohol consumption, and managing stress levels. "Lifestyle modification is seen as the cornerstone for essential hypertension prevention and treatment." (Moiz et. al, 2024)

3.2. Treatment options include"...a holistic approach to hypertension prevention, which includes health education, lifestyle modifications, and targeted interventions. This approach is crucial for improving the health and wellness of middle-aged and elderly individuals..." (Sutikno et. al, 2024)

4. Moiz A, Zolotarova T, & Eisenberg MJ. (2024). Outpatient management of essential hypertension: a review based on the latest clinical guidelines. Annals of Medicine, 56(1), 2338242. https://doi.org/10.1080/07853890.2024.2338242

4.1. References: McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

4.2. Sutikno E, Notobroto HB, Puspitasari N, Nurkhalim RF, & Oktaviasari DI. (2024). Prevention and management of hypertension in middle-aged and elderly through screening and education (Pre-post intervention). African Journal of Reproductive Health, 28(10s), 125–133. https://doi.org/10.29063/ajrh2024/v28i10s.15

5. Diagnostic to confirm primary diagnosis: Multiple visits to a Primary Care Provider that upon assessment an elevated blood pressure is obtained; (greater than or equal to 140/90). There are best pratices to follow such as, allowing the patient to have a seat for atleast 5-10 minutes after coming in, have the patient sit in an upright position with their feet flat on the floor.

5.1. Diagnostic Labs: CBC; CMP; thyroid

6. Consistent elevation of systemic arterial blood pressure.

7. "Hypertension was defined in 2014 as a sustained systolic blood pressure (SBP) of 140 mmHg or greater or a diastolic blood pressure (DBP) of 90 mmHg or greater." (McClance and Heuther, 2019)

8. Risk Factors: "...age, ethnicity, family history of hypertension and genetic factors, lower education and socioeconomic status, tobacco use, psychosocial stressors, sleep apnea, and dietary factors (including dietary fats, higher sodium intake, lower potassium intake, and excessive alcohol intake).5 Glucose intolerance (diabetes mellitus) and obesity also are significant risk factors." "HTN is higher in blacks and in those with diabetes."(McClance and Heuther, 2019)

9. Pathophyiology: "Hypertension is caused by increases in cardiac output, total peripheral resistance, or both. Cardiac output is increased by any condition that increases heart rate or stroke volume, whereas peripheral resistance is increased by any factor that increases blood viscosity or reduces vessel diameter (vasoconstriction)." (McClance and Heuther, 2019)

10. Signs and symptoms: Some hypertensive individuals never have signs, symptoms, or complications, whereas others become very ill, and hypertension can be a cause of death."(McClance and Heuther, 2019)

10.1. Usually asymptomatic

11. Medications include antihypertensives. "...initiation of antihypertensive therapy vary across guidelines, and are contingent on the grade of hypertension, risk of cardiovascular disease, and presence of comorbidities (Table 4)."(Moiz et. al, 2024)

11.1. "There are five major classes of first-line antihypertensive medications: thiazide/thiazide-like diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), calcium channel blockers (CCB) and beta-blockers [1]." (Moiz et. al, 2024)

12. Referral to a Cardiologist or a local cardiac clinic. Referrals to specialists may be necessary for instances of resistant hypertension. Referral to the Emergency Department would be necessary in instances of severe hypertension. Example: Blood Pressure Greater than >180/110