Hypertension (HTN)

Etiology

  • Hypertension is very common and typically asymptomatic, causing end organ damage over years (in concert w/other cardiovascular dz risk factors)
  • Hypertensive emergency: acute increases in BP beyond a threshold and/or otherwise very high values (i.e. acute end organ dysfxn): headache (intra-cerebral edema), cardiac ischemia, CHF, AKI, visual impairment, etc.

Risk Factors

  • Primary hypertension: obesity, family history, excessive sodium intake, age, lack of activity, smoking, diabetes
  • Secondary hypertension (consider if onset < 30, accelerated, other findings, or unexpectedly hard to control): OSA, meds/toxins (e.g. NSAIDs, ETOH), hyperaldosteronism, hypo or hyperthyroidism, CKD, hypercortisolism, renal artery stenosis, pheochromocytoma, growth hormone excess

Symptoms

  • Hypertensive emergency: Abrupt head ache, confusion (encephalopathy); SOB, chest pain, DOE (cardiac ischemia, CHF); Visual loss (retinal hemorrhage)
  • Chronic hypertension: Asymptomatic until target organs affected (e.g. symptoms associated w/CAD, CHF, CKD)

Physical Exam Findings

  • Normal BP < 120/80 mm Hg; Elevated: SBP 120-129 and DBP < 80 mm Hg; Stage I hypertension: SBP 130-39 or DBP 80-89 mm Hg; Stage II hypertension: SBP >= 140 or DBP >= 90 mm Hg
  • Hypertensive emergency: BP very high > 220/110 (though hard to predict on basis of absolute value)
  • Findings associated w/HTN include: CHF (chronic), PAD (diminished peripheral pulses), aneurysmal (AAA, TAA) disease, large vessel (aorta) dissection, abdominal bruits
  • Findings of hpyertensive emergency include: papilledema, retinal exudates or hemorrhages, heart failure, other acute target organ damage

Tests