high-blood-pressureHypertension is a potentially serious medical condition when blood pressure is elevated for a chronic or long period of time.

Also known as High blood pressure and HTN.

Normal blood pressure is typically 140/80 and below.

Too low of blood pressure is not necessarily great – low blood pressure is called hypotension.

More often seen in adults – children and even infants can suffer from Hypertension.

Blood pressure is the pressure of blood itself against the arteries

  • Similar to the amount of pressure it takes to blow up a balloon.
  • The difference is that blood is always moving and the air inside a balloon is contained

Two numbers measure blood pressure:

1.  Systolic pressure
2.  Diastolic pressure

Systolic – measures cardiac output
Diastolic – measures arterial resistance


Two main categories

1.)  Primary

  • When cause is unknown it also referred to as essential hypertension
  • 95% of the cases

2.)  Secondary

  • Occurs when the cause is known
  • 5% of cases


  • Many have no symptoms at all
  • Headache
  • Dizziness
  • Nausea
  • Heart racing
  • Vision changes

Symptoms in infants

  • Failure to thrive
  • Irritability
  • Seizures
  • Lethargy
  • Respiratory distress

*** – if hypertension is a secondary cause from another disease then symptoms of that disease are often present as well

Factors that play a key role include:

  • Age
  • Race
  • Obesity
  • Stress
  • Smoking
  • Genetics or heredity

*** Pregnancy induced hypertension can be seen and can lead to preeclampsia or eclampsia


  • Is when a persons blood pressure is elevated above the normal level
  • However, this level is not yet at the level to be considered hypertension.
  • Systolic is between 120 and 139 mm Hg
  • Diastolic is between 80 and 89 mm Hg
  • When over 140/90 mm Hg – is considered hypertension

Over 50 million Americans have High Blood Pressure

  • A large portion of thoes with this condition (65-70%) know they have increased blood pressure
  • Around 30% are not aware of their condition.
  • However, only 50% who are aware of their condition are taking medication
  • And only half who take medications are under 140/90



Essential Hypertension

  • This is a very complex disorder
  • By definition has no identifiable cause
  • Affects 90-95% of individuals with hypertension

Risk factors:

1.)  Increase Age
2.)  Increase Weight  (Obesity)
3.)  Sedentary lifestyle
4.)  Increase Alcohol intake
5.)  Increase Salt intake
6.)  Genetic changes

Secondary Hypertension

  • Seen in only 5% of those with hypertension

1.)  Endocrine diseases

2.)  Kidney diseases

  • Chronic renal failure
  • Kidney disease

3.)  Cancers

4.)  Medication

  • Alcohol
  • Stimulants
  • Hormonal contraception
  • Nasal decongestants
  • others

5.)  Pregnancy

6.)  Obstructive Sleep Apnea

7.)  Neurological disorders

8.)  others

Some major complications of hypertension are:

1.  Stroke
2.  Coronary Heart Disease
3.  End-stage Renal Failure
4.  Heart Failure
5.  Arterial Aneurysms



Resistant Hypertension

This is a difficult portion of this disease.

It is seen when someone with hypertension is still uncontrolled even though 3 or more medications are being used.

Only a small amount of those with hypertension will develpe this “resistance”


Exercise Hypertension

Elevated blood pressure only during exercise

The spike is often seen in the Systolic pressure which can exceed 250 mm Hg

Diagnosis often occurs when systolic goes above 200 mm Hg and medication is required when above 220 mm Hg



Diuretics for those with:


  • Hydrochlorothiazide
  • Metolazone
  • Chlorthilidone
  • Block sodium respoorption in cortical diluting segment – at terminal point of loop of Henle.
  • Become ineffective when GFR goes below 30-40 mL/min

Loop Diuretics

  • Furosemide
  • Bumetanide
  • Torsemide
  •  Inhibits chloride reabsorption in ascending limb of the loop of Henle

Potassium-Sparing agents

  • Spironolactone
  • Triamterene
  • Eplerenone
  • Amiloride
  • Can be used in combo with Loop diuretics and Thiazides
  • Triameterene and Amiloride work in distual tubule to limitpotassium secretion
  • Spironolactone inhibits aldosterone – which is often elevated in Congestive Heart Failure  (CHF)
  • Eplerenone is used for post MI cases  (heart attacks)

Beta-Blockers are intended for those with:

Beta Blockers

  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Betaxolol (Kerlone
  • Bisoprolol & HCTZ (Ziac)
  • Carteolol (Cartrol)
  • Carvedilol (Coreg)
  • Labetalol (Normodyne, Trandate)
  • Metoprolol (Lopressor, Toprol XL)
  • Nadolol (Corgard)
  • Penbutolol (Levatol)
  • Pindolol (Visken)
  • Propranolol (Inderal)
  • Timolol (Blocadren)

ACE Inhibitors are intended for those with:

ACE Inhibitors

  • Benazepril (Lotension)
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Fosinopril (Monopril)
  • Lisinopril (Prinivil, Zestril)
  • Moexipril (Univasc)
  • Perindopril (Aceon)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)
  • Block the rennin-angiotension-aldosterone system
  • Reduce deaths by 20% with those who have symptoms of Heart failure

ARBs are intended for those with:

Angiotension II Receptor Blockers

  • Candesartan (Atacand)
  • Eposartan (Teveten)
  • Irbesartan (Avapro)
  • Losartan (Cozaar)
  • Olmesartan (Benicar)
  • Telmisartan (Micardis)
  • Valsartan (Diovan)


  • Eposartan + HCTZ (Teveten HCTZ)
  • Irbesartan + HCTZ (Avalide)
  • Losartan + HCTZ (Hyzaar)
  • Olmesartan + HCTZ (Benicar HCT)
  • Telmisartan + HCTZ (Micardis HCT)
  • Valsartan + HCTZ (Diovan HCT)

CCB are intended for those with:

Calcium Channel Blocker

Nondihydropyridine Agents

  • Diltiazem (Cardizem, Dilacor, Tiazac)
  • Verapamil (Calan, Ssoptin, Verelan, Covera)


  • Amlodipine (Norvasc)
  • Felodipine (Plendil)
  • Isadipine (DynaCirc)
  • Nicardipine (Cardene)
  • Nifedipine (Adalat, Procardia)
  • Nisoldipine (Sular)

Alpha-Adrenoceptor Blockers

  • Prazosin (Minipress)
  • Terazosin (Hytrin)
  • Doxazosin (Cardura)

Central Sympatholytics

  • Cloidine (Catapres, Wytensin, Tenex, Aldomet)
  • Guanfacine (Tenex)
  • Guanabenz (Wytensin)
  • Methyldopa (Aldomet)

Peripheral Neuronal Antagonists

  • Reserpine (Serpasil)

Aldosterone Antagonists for those with:

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report in JAMA 2003; 289:2560


  • The Dietary Guidelines for Americans reports adults should not consume more than 2,400 milligrams of sodium daily.
  • It is believed that foods high in Omega and/or Fatty acids can help hypertension
  • Calcium and Magnesium may be helpful
  • Increase Fruits and Vegetables
  • Increase low-fat dairy products

Drugs for Hypertensive Emergiencies

  • Nitroprusside [Nipride]
  • Nitroglycerin
  • Labetalol [Normodyne, Trandate]
  • Esmolol [Brevibloc]
  • Nicardipine [Cardene]
  • Nifedipine [ Adalat, Procardia]
  • Clonidine [Catapres]
  • Captopril [Capoten}
  • And others
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