When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Essential hypertension

Last reviewed: 3 Sep 2024
Last updated: 30 Apr 2024

Summary

Definition

History and exam

Key diagnostic factors

  • systolic blood pressure (BP) ≥130 mmHg or diastolic BP ≥80 mmHg
  • retinopathy
Full details

Other diagnostic factors

  • headache
  • visual changes
  • dyspnea
  • chest pain
  • sensory or motor deficit
Full details

Risk factors

  • obesity
  • aerobic exercise <3 times/week
  • moderate/high alcohol intake
  • metabolic syndrome
  • diabetes mellitus
  • black ancestry
  • age >60 years
  • family history of hypertension or chronic coronary disease
  • sleep apnea
  • sodium intake >1.5 g/day
  • low fruit and vegetable intake
  • dyslipidemia
Full details

Diagnostic tests

1st tests to order

  • ECG
  • fasting metabolic panel with estimated GFR
  • lipid panel
  • urinalysis
  • Hb
  • thyroid-stimulating hormone
Full details

Tests to consider

  • urinary albumin to creatinine ratio
  • plasma renin activity
  • plasma aldosterone
  • renal duplex ultrasound/MRA renal arteries/CT angiography
  • 24-hour urine pheochromocytoma screen
  • plasma fractionated metanephrines
  • 24-hour urine free cortisol
  • sleep study
  • echocardiography
Full details

Treatment algorithm

ACUTE

without chronic renal disease or cardiovascular disease (CVD)-related comorbidity: stage 1 hypertension and lower CVD risk and without diabetes

without chronic renal disease or cardiovascular disease (CVD)-related comorbidity: higher CVD risk or with diabetes

concomitant chronic coronary disease without congestive heart failure

concomitant heart failure (HF)

concomitant left ventricular hypertrophy without chronic coronary disease

concomitant chronic renal disease without cardiovascular disease

concomitant atrial fibrillation without other comorbidity

ONGOING

refractory/resistant to optimized triple therapy at any stage: without congestive heart failure

Contributors

Authors

Jeffrey Brettler, MD, FASH

Internal Medicine

Regional Hypertension Co-lead, Kaiser Permanente Southern California, Los Angeles

Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena

CA

Disclosures

JB declares that he has no competing interests.

Acknowledgements

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 topic.

Disclosures

JH, JNB, MA, LB, and MAS declare that they have no competing interests.

Peer reviewers

Isla Mackenzie, MBChB, PhD, FRCP

Clinical Senior Lecturer in Clinical Pharmacology and Honorary Consultant Physician

University of Dundee

Dundee

UK

Disclosures

IM is an elected member of the British Hypertension Society Executive Committee.

Syed Wamique Yusuf, MRCPI, FACC

Associate Professor

Department of Cardiology

University of Texas MD Anderson Cancer Center

Houston

TX

Disclosures

SWY declares that he has no competing interests.

Melvin Lobo, MBChB, PhD, MRCP

Director Barts Blood Pressure Centre of Excellence

NHS Reader in Cardiovascular Medicine

Department of Clinical Pharmacology

William Harvey Heart Centre

London

UK

Disclosures

ML is a consultant for ROX Medical. ML receives honorarium from Cardiosonic, St. Jude Medical, and institutional grant/research support from Medtronic.

  • Differentials

    • Drug-induced hypertension
    • Chronic kidney disease
    • Renal artery stenosis
    More Differentials
  • Guidelines

    • Standards of care in diabetes
    • 2023 ESH Guidelines for the management of arterial hypertension
    More Guidelines
  • Patient information

    High blood pressure

    High blood pressure: questions to ask your doctor

    More Patient information
  • Calculators

    Glomerular Filtration Rate Estimate by the IDMS-Traceable MDRD Study Equation

    CKD-EPI equations for glomerular filtration rate (GFR)

    More Calculators
  • Videos

    How to perform an ECG: animated demonstration

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer