Typically diagnosed by screening of an asymptomatic individual.
Treatment of uncontrolled hypertension 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 hypertension is defined as BP ≥140/90 mmHg, 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. August 2004. http://www.nhlbi.nih.gov/ (last accessed 5 October 2016).
http://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf
[2]
Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009;27:2121-2158.
http://www.ncbi.nlm.nih.gov/pubmed/19838131?tool=bestpractice.com
[3]
Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159-2219.
http://eurheartj.oxfordjournals.org/content/34/28/2159.long
http://www.ncbi.nlm.nih.gov/pubmed/23771844?tool=bestpractice.com
[4]
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507-520.
http://jama.jamanetwork.com/article.aspx?articleid=1791497
http://www.ncbi.nlm.nih.gov/pubmed/24352797?tool=bestpractice.com
The main goal of treatment is to decrease the risk of mortality and of cardiovascular and renal morbidity.
[5]
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. HOT Study Group. Lancet. 1998 Jun 13;351(9118):1755-62.
http://www.ncbi.nlm.nih.gov/pubmed/9635947?tool=bestpractice.com
The Eighth Joint National Committee (JNC 8) guideline recommends starting pharmacologic treatment in patients with chronic kidney disease and diabetes if BP ≥140/90 mmHg.
[4]
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507-520.
http://jama.jamanetwork.com/article.aspx?articleid=1791497
http://www.ncbi.nlm.nih.gov/pubmed/24352797?tool=bestpractice.com
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.
[3]
Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159-2219.
http://eurheartj.oxfordjournals.org/content/34/28/2159.long
http://www.ncbi.nlm.nih.gov/pubmed/23771844?tool=bestpractice.com
This supersedes the earlier ESH/ESC target of <130/80 mmHg for patients with diabetes mellitus,
[6]
Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension. Eur Heart J. 2007 Jun;28(12):1462-536.
http://eurheartj.oxfordjournals.org/content/28/12/1462.full
http://www.ncbi.nlm.nih.gov/pubmed/17562668?tool=bestpractice.com
which was not supported by evidence from randomized controlled trials. In two trials and one meta-analysis, benefit was apparent when diastolic BP was reduced to between 80 and 85 mmHg.
[7]
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. HOT Study Group. Lancet. 1998;351:1755-1762.
http://www.ncbi.nlm.nih.gov/pubmed/9635947?tool=bestpractice.com
[8]
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703-713.
http://www.bmj.com/content/317/7160/703
http://www.ncbi.nlm.nih.gov/pubmed/9732337?tool=bestpractice.com
[9]
Reboldi G, Gentile G, Angeli F, et al. Effects of intensive blood pressure reduction on myocardial infarction and stroke in diabetes: a meta-analysis in 73,913 patients. J Hypertens. 2011;29:1253-1269.
http://www.ncbi.nlm.nih.gov/pubmed/21505352?tool=bestpractice.com
None of these studies reduced systolic BP below 130 mmHg.
Blood pressure goals and recommendations continue to evolve in line with new evidence.
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline defines hypertension as any systolic blood pressure measurement of 130 mmHg or higher or any diastolic BP measurement of 80 mmHg or higher.
[10]
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. 2017 Nov 7 [Epub ahead of print].
http://www.onlinejacc.org/content/accj/early/2017/11/04/j.jacc.2017.11.006.full.pdf?_ga=2.115307335.1974997024.1516902202-1609373140.1516902202
http://www.ncbi.nlm.nih.gov/pubmed/29146535?tool=bestpractice.com
This definition differs from the JNC 8, ESH, and ESC guidelines.
The SPRINT trial (Systolic Blood Pressure Intervention Trial) found that a lower systolic target of 120 mmHg (as measured by automated office blood pressure) reduced cardiovascular complications and deaths in people ages over 50 years with high blood pressure and at least one additional risk factor for heart disease.
[11]
The SPRINT Study Research Group. Systolic Blood Pressure Intervention Trial. 2015. www.sprinttrial.org/ (last accessed 5 October 2016).
https://www.sprinttrial.org/public/dspHome.cfm
[12]
Wright JT Jr, Williamson JD, Whelton PK, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood pressure control. N Engl J Med. 2015;373:2103-2116.
http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=article
http://www.ncbi.nlm.nih.gov/pubmed/26551272?tool=bestpractice.com
Patients with diabetes or stroke were excluded from the trial.