Summary
Information for patients
Definitions [1-2]
- Hypertension in adults and children
≥ 16
years: persistent office systolic blood pressure (SBP) ≥
140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg. [1]
- Hypertension in children < 16 years: systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) persistently ≥ 95th percentile for sex, age and height. [2]
- Essential hypertension: Hypertension with no identifiable cause
- Secondary hypertension: Hypertension due to an underlying condition
- Resistant hypertension: Hypertension uncontrolled despite at least 3 anti-hypertensives (in maximal or maximally tolerated doses) including a diuretic.
Classification [1-2]
- Optimal: SBP < 120 mmHg and DBP < 80 mmHg
- Normal: SBP 120-129 mmHg and/or DBP 80-84 mmHg
- High-normal: SBP 130-139 mmHg and/or DBP 85-89 mmHg
- Grade 1 hypertension: SBP 140-159 mmHg and/or DBP 90-99 mmHg
- Grade 2 hypertension: SBP 160-179 mmHg and/or DBP 100-109 mmHg
- Grade 3 hypertension: SBP ≥ 180 mmHg and/or DBP ≥ 110 mmHg
Pathophysiology/Etiology
Essential hypertension:
- Due to an impaired response of the renin-angiotensin-aldosterone system which leads to peripheral vasoconstriction and increased salt reabsorption with consequent volume expansion and increased afterload.
Secondary hypertension
- Renal: renal artery stenosis, renal parenchymal disease
- Endocrine: primary hyperaldosteronism, pheochromocytoma, Cushing syndrome, hyperthyroidism
- Cardiovascular: coarctation of the aorta
- Pulmonary: obstructive sleep apnea
- Pharmacology: oral contraceptives, corticosteroids, NSAIDs, psychostimulants
Diagnosis
- Elevated in-office blood pressure on at least three different occasions, with an additional reading if two of the readings differ by >10 mmHg.
- Out-of-office blood pressure measurement is recommended as an alternative strategy to repeated office blood pressure to confirm the diagnosis of hypertension.
- Ambulatory blood pressure monitoring (ABPM) or home blood pressure measurements (HBPM) can be used in other cases, such as to diagnose masked or white-coat hypertension.
Treatment
1. Lifestyle interventions
- Weight control
- Moderation of alcohol consumption
- Sugar-sweetened soft drinks restriction
- Smoking cessation
2. Diet
- Salt restriction
- Mediterranean diet promotion
3. Exercise
4. Drugs
- Angiotensin-converting enzyme inhibitors
- Angiotensin receptor blockers
- Beta-blockers
- Calcium channel blockers
- Thiazide diuretics
Exercise training
Pre-exercise screening
Clinical evaluation
ECG
Exercise testing
Exercise prescription
• Aerobic endurance training
References
[1] 2018 European Society of Hypertension (ESC/ESH)
[2] 2020 International Society of Hypertension (ISH)
