Defined as BP ≥140/90 mmHg.
Typically diagnosed by screening of an asymptomatic individual.
Treatment of uncontrolled HTN reduces the risks of mortality and of cardiac, vascular, renal, or cerebrovascular complications.
Lifestyle changes are recommended for all patients: weight loss, exercise, decreased sodium intake, and moderation of alcohol consumption.
Choice of drug therapy is often driven by considerations related to comorbid disease, but achievement of BP goal may be accomplished with a variety of therapeutic agent(s).
Essential HTN is defined as BP ≥140/90 mmHg, with no secondary cause identified.     The main goal of treatment is to decrease the risk of mortality and of cardiovascular and renal morbidity. 
The Eighth Joint National Committee (JNC 8) guideline recommends starting pharmacological treatment in chronic kidney disease and diabetes patients if BP ≥140/90 mmHg.  In the general population aged ≥60 years, treatment to lower blood pressure should begin when BP ≥150/90 mmHg. The latter recommendation was not agreed upon by all panel members because of the risk of cardiovascular events associated with BP ≥140/90 mmHg.
In the 2013 European Society of Hypertension (ESH) and European Society of Cardiology (ESC) guidelines, target BP is defined as <140/85 mmHg in patients with type 2 diabetes mellitus and <140/90 mmHg in all other patients.  This supersedes the earlier ESH/ESC target of <130/80 mmHg for patients with diabetes mellitus,  which was not supported by evidence from randomised controlled trials. In two trials and one meta-analysis, benefit was apparent when diastolic BP was reduced to between 80 and 85 mmHg.    None of these studies reduced systolic BP below 130 mmHg.
In the ABCD (Appropriate Blood Pressure Control in Diabetes) trial of 480 normotensive patients with type 2 diabetes mellitus, systolic BP of <130 mmHg was achieved in patients receiving intensive therapy.  However, cardiovascular events were not consistently reduced over a mean follow-up period of 5.3 years.
In the ACCORD study of patients with type 2 diabetes mellitus, targeting systolic BP of <120 mmHg did not reduce the incidence of major cardiovascular events compared with systolic BP of 140 mmHg in the standard therapy group. 
Pre-HTN is defined as systolic BP 120 to 139 mmHg and diastolic BP 80 to 89 mmHg. 
Blood pressure goals and recommendations continue to evolve in line with new evidence.
Internal Medicine and Assistant Area Medical Director
JB declares that he has no competing interests.
Dr Jeffrey Brettler would like to gratefully acknowledge Dr Joel Handler, Dr Jonathan N. Bella, Dr Moustapha Atoui, Dr Liran Blum, and Dr Michael A. Spinelli, previous contributors to this monograph. JH, JNB, MA, LB, and MAS declare that they have no competing interests.
Clinical Senior Lecturer in Clinical Pharmacology and Honorary Consultant Physician
University of Dundee
IM is an elected member of the British Hypertension Society Executive Committee.
Department of Cardiology
University of Texas MD Anderson Cancer Center
SWY declares that he has no competing interests.
Director Barts Blood Pressure Centre of Excellence
NHS Reader in Cardiovascular Medicine
Department of Clinical Pharmacology
William Harvey Heart Centre
ML is a consultant for ROX Medical. ML receives honorarium from Cardiosonic, St. Jude Medical, and institutional grant/research support from Medtronic.
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