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Hypertension (Code 610): Definition, Diagnosis & Management

Definition

Hypertension (HTN) is a chronic condition where blood pressure is persistently elevated. It's a major risk factor for heart disease, stroke, kidney failure, and vascular dementia.

Diagnostic Criteria (ACC/AHA 2017)

CategorySystolic (mmHg)Diastolic (mmHg)
Normal<120<80
Elevated120-129<80
Stage 1 HTN130-13980-89
Stage 2 HTN≥140≥90
Hypertensive Crisis>180>120

Diagnosis requires average of ≥2 readings on ≥2 occasions.

Symptoms

Often asymptomatic ("silent killer"). When present:

  • Headaches (typically morning, occipital)
  • Dizziness, fatigue
  • Visual changes, epistaxis
  • Chest pain, dyspnea (if target organ damage)

Evaluation

  • Comprehensive history & physical
  • Laboratory: CBC, CMP, lipids, fasting glucose/HbA1c, TSH, urinalysis
  • ECG, consider echocardiogram
  • Assess ASCVD risk (Pooled Cohort Equations)

Treatment

Lifestyle Modifications (All Stages)

  • DASH diet (rich in fruits, vegetables, low-fat dairy; low sodium <1500mg/day)
  • Weight loss (if BMI ≥25)
  • Physical activity: ≥150 min/week moderate intensity
  • Limit alcohol: ≤2 drinks/day (men), ≤1 (women)
  • Smoking cessation
  • Stress management

Pharmacotherapy

Stage 1 + ASCVD risk ≥10% or existing CVD/CKD/DM: Start medication + lifestyle
Stage 2: Start 2 first-line agents + lifestyle

First-line classes: Thiazide diuretics, ACE inhibitors, ARBs, CCBs (calcium channel blockers)

Compelling indications guide selection: Diabetes→ACEI/ARB; HF→ACEI/ARB/ARNI+BB+MRA; Post-MI→BB+ACEI; CKD→ACEI/ARB

Monitoring & Goals

  • General goal: <130/80 mmHg
  • Home BP monitoring validated devices
  • Follow-up: monthly until controlled, then 3-6 months
  • Assess adherence, side effects, electrolytes, renal function

Prognosis

With effective management, most patients achieve control and reduce cardiovascular risk. Lifelong adherence to therapy and lifestyle is essential.

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