Essential hypertension

Essential hypertension is typically diagnosed by screening of an asymptomatic individual.

Treatment of uncontrolled hypertension reduces the risks of mortality and of cardiac, vascular, renal, and cerebrovascular complications.

Lifestyle changes are recommended for all patients: weight loss, exercise, decreased sodium intake, Dietary Approaches to Stop Hypertension (DASH) diet, and moderation of alcohol consumption.

Choice of drug therapy is often driven by considerations related to comorbid disease, but achievement of blood pressure goal may be accomplished with a variety of therapeutic agent(s).

Essential hypertension is defined as persistently raised blood pressure (BP) with no secondary cause identified.[1]National Heart, Lung, and Blood Institute. The seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Aug 2004 [internet publication]. https://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf [2]Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-104. https://academic.oup.com/eurheartj/article/39/33/3021/5079119 http://www.ncbi.nlm.nih.gov/pubmed/30165516?tool=bestpractice.com [3]Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248. https://www.jacc.org/doi/full/10.1016/j.jacc.2017.11.006 http://www.ncbi.nlm.nih.gov/pubmed/29146535?tool=bestpractice.com ​​ The main goal of treatment is to decrease the risk of mortality and of cardiovascular and renal morbidity.[4]Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet. 1998 Jun 13;351(9118):1755-62. http://www.ncbi.nlm.nih.gov/pubmed/9635947?tool=bestpractice.com

The American College of Cardiology (ACC)/American Heart Association (AHA) guideline defines hypertension as systolic BP measurement of ≥130 mmHg or diastolic BP measurement of ≥80 mmHg.[3]Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248. https://www.jacc.org/doi/full/10.1016/j.jacc.2017.11.006 http://www.ncbi.nlm.nih.gov/pubmed/29146535?tool=bestpractice.com

The European Society of Cardiology (ESC) and European Society of Hypertension (ESH) guidelines define hypertension as office systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, which is equivalent to a 24-hour ambulatory BP measurement average of ≥130/80 mmHg, or a home BP measurement average of ≥135/85 mmHg.[2]Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-104. https://academic.oup.com/eurheartj/article/39/33/3021/5079119 http://www.ncbi.nlm.nih.gov/pubmed/30165516?tool=bestpractice.com [5]Mancia G, Kreutz R, Brunström M, et al. 2023 ESH guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023 Jun 21. https://journals.lww.com/jhypertension/fulltext/9900/2023_esh_guidelines_for_the_management_of_arterial.271.aspx http://www.ncbi.nlm.nih.gov/pubmed/37345492?tool=bestpractice.com

The World Health Organization (WHO) recommends starting pharmacologic antihypertensive treatment in patients with a confirmed diagnosis of hypertension and systolic BP of ≥140 mmHg or diastolic BP of ≥90 mmHg.[6]World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. Aug 2021 [internet publication]. https://www.who.int/publications/i/item/9789240033986

BP goals and recommendations continue to evolve in line with new evidence.