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{{Template:Hypertension}}
{{Chronic hypertension}}


{{CMG}}; '''Assistant Editor-In-Chief:''' Taylor Palmieri
{{CMG}}; '''Assistant Editor-In-Chief:''' [[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]]


==Overview==
==Overview==
Hypertension is usually found incidentally  by healthcare professionals during a routine checkup. The only test for hypertension is a blood pressure measurement.
Thorough history-taking is crucial for the diagnosis and assessment of hypertension. Not only should history-taking be targeted to identify symptoms consistent with high blood pressure, but more importantly it should address risk factors and target organ damage. History-taking alone may be sufficient to diagnose some causes of [[secondary hypertension]], such as drug-induced hypertension, and may allow a more targeted evaluation of the cause and treatment of the hypertension.


==History and Symptoms==
==Symptoms of Hypertension==
Hypertension in isolation usually produces no symptoms although some people may report either:
Most patients with hypertension are asymptomatic at the time of diagnosis. Common symptoms are listed below:  
*[[Blurred vision]]
*[[Headache]]
*[[Dizziness]]
*[[Blurry vision]]
*[[Facial flushing]]
*[[Dyspnea]]
*[[Epistaxis]]
*[[Tinnitus]]
*[[Fatigue]]
*[[Fatigue]]
*[[Headaches]]
*[[Drowsiness]]
*[[Tinnitus]]
 
==Symptoms Suggestive of Secondary Hypertension==
Other symptoms that might suggest secondary etiologies of hypertension include:
*[[Sleep apnea]] is suggested by [[obesity]], [[snoring]] and [[apnea]]
*[[Hyperaldosteronism]] is suggested by [[fatigue]], [[headache]], intermittent [[paralysis]], [[muscle weakness]], and [[numbness]]
*[[Pheochromocytoma]] is suggested by the triad of a [[headache]], [[sweating]], and [[palpitations]] in a young person
*[[Cushing's syndrome]] is suggested by a rapid [[obesity|weight gain]], particularly of the trunk and face with sparing of the limbs ([[central obesity]]), a round face often referred to as a "[[moon face]]", excess [[sweating]], [[insomnia]], reduced [[libido]], [[impotence]], [[amenorrhoea]], [[infertility]] and psychological disturbances, ranging from [[Euphoria (emotion)|euphoria]] to [[psychosis]]. [[clinical depression|Depression]] and [[anxiety]].<ref>{{cite book |title=The American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences |last=Yudofsky |first=Stuart C. |coauthors=Robert E. Hales |edition=5th |year=2007 |publisher=American Psychiatric Pub, Inc. |isbn=1585622397 }}</ref>
*An extensive list of drugs can be associated with hypertension. The most common agents include immunosuppressive agents, non-steroidal anti-inflammatory drugs, [[oral contraceptive pills]], some weight loss agents, stimulants, monoamine oxidase inhibitors, triptans, ergotamines, and sympathomimetics.<ref name="pmid12537168">{{cite journal| author=Onusko E| title=Diagnosing secondary hypertension. | journal=Am Fam Physician | year= 2003 | volume= 67 | issue= 1 | pages= 67-74 | pmid=12537168 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12537168  }} </ref> A more extensive list of drugs includes [[almotriptan]], [[dihydroergotamine]], [[ergotamine]], [[frovatriptan]], [[isometheptene]], [[rizatriptan]], [[sumatriptan]], [[zolmitriptan]], [[amitriptyline]], [[cyclosporine]], [[desipramine]], [[doxepin]], [[ephedrine]], [[glucocorticoid resistance ]], [[imipramine]], [[monoamine oxidase inhibitor]]s, [[nasal decongestants]], [[nortriptyline]], [[NSAIDs]], [[combined oral contraceptive pill]], [[phencyclidine]], [[phenylpropanolamine]], [[protriptyline]], [[pseudoephedrine]], [[sedative dependence]], [[serotonin toxicity]], [[steroid abuse]], and [[cocaine]].
 
==Assess Risk Factors==
*Age
*Ethnicity
*[[Tobacco]]
*Medications
*Family history
*[[Alcohol]]
*[[Dyslipidemia]]
*[[Diabetes mellitus]]
*Known cardiovascular diseases
*Known kidney diseases
*Diet
*[[Obesity]]
*Sedentary lifestyle


[[Malignant hypertension]] (or accelerated hypertension) is distinct as a late phase in the condition, and may present with [[headaches]], [[blurred vision]] and end-organ damage. Large [[lunula]]e (more than 25% of the thumb nail) are also a sign of high blood pressure.
==Symptoms of Target Organ Damage==
===Eyes===
*[[Retinopathy]]


Hypertension is often confused with mental tension, stress and [[anxiety]]. While chronic anxiety is associated with poor outcomes in people with hypertension, it alone does not cause it. Accelerated hypertension is associated with [[somnolence]], [[confusion]], visual disturbances, and [[nausea]] and [[vomiting]] (hypertensive encephalopathy).
===Heart===
*[[Angina]]
*Prior [[MI]]
*Prior coronary revascularizations
*[[Aneurysm]]s
*Symptoms of [[heart failure]]
*Symptoms of [[peripheral vascular disease]] ([[PVD]])


=== Hypertensive Urgencies and Emergencies ===
===Kidneys===
Hypertension is rarely severe enough to cause symptoms. These typically only surface with a [[systolic blood pressure]] over 240 mmHg and/or a [[diastolic blood pressure]] over 120 mmHg.  These pressures without signs of end-organ damage (such as renal failure) are termed "accelerated" hypertension. When end-organ damage is possible or already ongoing, but in absence of raised [[intracranial pressure]], it is called [[hypertensive emergency]]. Hypertension under this circumstance needs to be controlled, but prolonged hospitalization is not necessarily required. When hypertension causes increased intracranial pressure, it is called [[malignant hypertension]]. Increased intracranial pressure causes [[papilledema]], which is visible on [[ophthalmoscopy|ophthalmoscopic]] examination of the [[retina]].
*[[Proteinuria]]
*[[Hematuria]]
*[[Renal failure]]


=== Pregnancy ===
===Brain===
{{main|Hypertension of pregnancy}}
*[[Stroke]]
Although few women of childbearing age have high blood pressure, up to 10% develop [[hypertension of pregnancy]]. While generally benign, it may herald three complications of pregnancy: [[pre-eclampsia]], [[HELLP syndrome]] and [[eclampsia]]. Follow-up and control with medication is therefore often necessary.
*[[Intracranial hemorrhage]]
*[[Transient ischemic attack]] ([[TIA]])
*[[Dementia]]


===Children and adolescents ===
==2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)<ref name="pmid23771844">{{cite journal| author=Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A et al.| title=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). | journal=Eur Heart J | year= 2013 | volume= 34 | issue= 28 | pages= 2159-219 | pmid=23771844 | doi=10.1093/eurheartj/eht151 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23771844  }} </ref>==
As with adults, blood pressure is a variable parameter in children. It varies between individuals and within individuals from day to day and at various times of the day. The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking.  


Most childhood hypertension, particularly in preadolescents, is secondary to an underlying disorder. Renal parenchymal disease is the most common (60 to 70 percent) cause of hypertension. Adolescents usually have primary or essential hypertension, making up 85 to 95 percent of cases. <ref name=aafp>{{cite web | GREGORY B. LUMA, M.D., and ROSEANN T. SPIOTTA, M.D., Jamaica Hospital Medical Center | title =Hypertension in Children and Adolescents | publisher=American Academy of Family Physicians | work =Hypertension in Children and Adolescents | url=http://www.aafp.org/afp/20060501/1558.html | year = 2006}}</ref>
===Summary of Recommendations on History (DO NOT EDIT)<ref name="pmid23771844">{{cite journal| author=Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A et al.| title=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). | journal=Eur Heart J | year= 2013 | volume= 34 | issue= 28 | pages= 2159-219 | pmid=23771844 | doi=10.1093/eurheartj/eht151 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23771844  }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[EHS ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1. '''It is recommended to obtain a comprehensive medical history and physical examination in all patients with hypertension to verify the diagnosis, detect causes of secondary hypertension, record CV risk factors, and to identify OD and other CVDs.. ''([[EHS ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2. '''Obtaining a family history is recommended to investigate familial predisposition to hypertension and CVDs.''([[EHS ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WH}}

Latest revision as of 14:03, 17 May 2017

Chronic Hypertension Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Yazan Daaboul, Serge Korjian

Overview

Thorough history-taking is crucial for the diagnosis and assessment of hypertension. Not only should history-taking be targeted to identify symptoms consistent with high blood pressure, but more importantly it should address risk factors and target organ damage. History-taking alone may be sufficient to diagnose some causes of secondary hypertension, such as drug-induced hypertension, and may allow a more targeted evaluation of the cause and treatment of the hypertension.

Symptoms of Hypertension

Most patients with hypertension are asymptomatic at the time of diagnosis. Common symptoms are listed below:

Symptoms Suggestive of Secondary Hypertension

Other symptoms that might suggest secondary etiologies of hypertension include:

Assess Risk Factors

Symptoms of Target Organ Damage

Eyes

Heart

Kidneys

Brain

2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)[3]

Summary of Recommendations on History (DO NOT EDIT)[3]

Class I
"1. It is recommended to obtain a comprehensive medical history and physical examination in all patients with hypertension to verify the diagnosis, detect causes of secondary hypertension, record CV risk factors, and to identify OD and other CVDs.. (Level of Evidence: C)"
"2. Obtaining a family history is recommended to investigate familial predisposition to hypertension and CVDs.(Level of Evidence: B)"

References

  1. ↑ Yudofsky, Stuart C. (2007). The American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences (5th ed.). American Psychiatric Pub, Inc. ISBN 1585622397. Unknown parameter |coauthors= ignored (help)
  2. ↑ Onusko E (2003). "Diagnosing secondary hypertension". Am Fam Physician. 67 (1): 67–74. PMID 12537168.
  3. ↑ 3.0 3.1 Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A; et al. (2013). "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. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. PMID 23771844.

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