Especially severe cases of hypertension, or hypertensive crises, are defined as a BP ≥ 180/120 mm Hg and may be further categorized as hypertensive emergencies or urgencies. Hypertensive emergencies are characterized by evidence of impending or progressive target organ dysfunction, whereas hypertensive urgencies do not include progressive target organ dysfunction. In hypertensive emergencies, the BP should be aggressively lowered within minutes to an hour by no more than 25%, and then lowered to 160/100-110 mm Hg within the next 2-6 hours.

For more on the hypertensive crises, read here.

The seventh report of the Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure (JNC 7) identifies the following as major cardiovascular risk factors:

• Hypertension: component of metabolic syndrome

• Tobacco use, particularly cigarettes, including chewing tobacco

• Elevated LDL cholesterol (or total cholesterol ≥ 240 mg/dL) or low HDL cholesterol: component of metabolic syndrome

• Diabetes mellitus: component of metabolic syndrome

• Obesity (BMI ≥ 30 kg/m²): component of metabolic syndrome

• Age > 55 years for men or > 65 years for women: increased risk begins at the respective ages; the Adult Treatment Panel III used earlier age cutpoints to suggest the need for earlier action

• Estimated glomerular filtration rate <60 mL/min per 1.73 m²

• Microalbuminuria

• Family history of premature cardiovascular disease (men < 55 years; women < 65 years)

• Lack of exercise

For more on cardiovascular risk factors, read here.

The JNC 7 recommends the following screening tests for specific identifiable causes of hypertension:

• Chronic kidney disease: Estimated glomerular filtration rate

• Coarctation of the aorta: CT angiography

• Cushing syndrome; other states of glucocorticoid excess (eg, chronic steroid therapy): Dexamethasone suppression test

• Drug-induced/drug-related hypertension: Drug screening

• Pheochromocytoma: 24-hour urinary metanephrine and normetanephrine

• Primary aldosteronism, other states of mineralocorticoid excess: 24-hour urinary aldosterone level, specific mineralocorticoid tests

• Renovascular hypertension: Doppler flow ultrasonography, magnetic resonance angiography, CT angiography

• Sleep apnea: Sleep study with oxygen saturation (screening would also include the Epworth Sleepiness Scale [ESS])

• Thyroid/parathyroid disease: Thyroid-stimulating hormone level, serum parathyroid hormone level

For more on hypertension screening, read here.

Uncontrolled and prolonged BP elevation can lead to a variety of changes in the myocardial structure, coronary vasculature, and conduction system of the heart. These changes in turn can lead to the development of left ventricular hypertrophy, coronary artery disease, various conduction system diseases, and systolic and diastolic dysfunction of the myocardium, which manifest clinically as angina or myocardial infarction, cardiac arrhythmias (especially atrial fibrillation), and congestive heart failure.

For more information on diseases associated with hypertension, read here.

According to the SPRINT findings, achieving a target systolic pressure of 120 mm Hg reduced cardiovascular events (eg, myocardial infarction, heart failure) and stroke by nearly one third and reduced risk for death by almost one fourth when compared with a target of 140 mm Hg.

For more on the treatment of hypertension, read here.

 

Medscape © 2016  WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this article: Yasmine S. Ali, Eric H. Yang, David H. Adler. Quiz: How Much Do You Know About Hypertension? Medscape. Feb 09, 2016.