Hypertension (HTN) is a common condition that affects one in every three adults in the United States and is becoming increasingly prevalent among children. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines define hypertension in adults as a blood pressure of ≥ 130/80 mm Hg and the Eighth Joint National Committee (JNC 8) criteria specify ≥ 140/90 mm Hg. Hypertension can be classified as either primary (essential) or secondary. Primary hypertension accounts for ∼ 90% of cases of hypertension and has no detectable cause, whereas secondary hypertension is caused by a specific underlying condition. Typical underlying conditions include renal, endocrine, and vascular diseases (e.g., renal failure, primary hyperaldosteronism, coarctation of the aorta). Clinically, hypertension is usually asymptomatic until organ damage occurs, with the brain, heart, kidneys, and/or eyes (e.g., retinopathy, myocardial infarction, stroke) most commonly affected. If present, early symptoms of hypertension may include headache, dizziness, tinnitus, and chest discomfort. Hypertension is suspected if in-office blood pressure is persistently elevated on two or more separate measurements and is confirmed with out-of-office measurement. Further diagnostic measures include assessment of cardiovascular risk, evaluation of possible target organ damage (e.g., kidney function tests), and additional tests if an underlying disease is suspected. Treatment of primary hypertension includes lifestyle changes (e.g., diet, weight loss, exercise) and pharmacotherapy. Commonly prescribed antihypertensive medications include angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), thiazide diuretics, and calcium channel blockers (CCBs); pharmacological management of pediatric and pregnant patients differs, as some of these drugs are contraindicated in these patient populations. To treat secondary hypertension, the underlying cause needs to be addressed.
