Overview of hypertension in adults
- Jan Basile, MD
Jan Basile, MD
- Professor of Medicine
- Medical University of South Carolina
- Ralph H Johnson Veterans Affairs Medical Center
- Michael J Bloch, MD, FACP, FASH, FSVM, FNLA
Michael J Bloch, MD, FACP, FASH, FSVM, FNLA
- Associate Professor, University of Nevada School of Medicine
- Medical Director, Vascular Care, Renown Regional Medical Center
- Section Editors
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- Deputy Editors
- Daniel J Sullivan, MD, MPH
Daniel J Sullivan, MD, MPH
- Deputy Editor — Primary Care (Adult)
- Assistant Professor of Medicine
- Harvard Medical School
- John P Forman, MD, MSc
John P Forman, MD, MSc
- Senior Deputy Editor — UpToDate
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
The treatment of hypertension is the most common reason for office visits of nonpregnant adults to clinicians in the United States and for use of prescription drugs . The National Health and Nutrition Examination Survey (NHANES) conducted from 2005 through 2008 estimated that approximately 29 to 31 percent of adults in the US have hypertension . Extrapolating from these data, approximately 76.4 million Americans over the age of 20 years have hypertension . Data from NHANES 1999-2006 suggest that as many as 8 percent of US adults have undiagnosed hypertension.
The number of patients with hypertension is likely to grow as the population ages since either isolated systolic hypertension or combined systolic and diastolic hypertension occurs in the majority of persons older than 65 years (figure 1) . The rising incidence of obesity will also increase the number of hypertensive individuals . (See "Treatment of hypertension in the elderly patient, particularly isolated systolic hypertension".)
Despite the prevalence of hypertension and its associated complications, control of the disease is far from adequate. Although rates of hypertension awareness, treatment, and control have improved over the past few decades, data from NHANES 2005-2008 show that only 50.1 percent of persons with hypertension have their blood pressure under control, which was defined as a level below 140/90 mmHg (table 1) [4,5].
There are numerous potential reasons for low rates of blood pressure control, including poor access to health care and medications as well as lack of adherence with long-term therapy for a condition that is usually asymptomatic . The latter may be particularly true when the therapy may interfere with the patient's quality of life and when its immediate benefits may not be obvious to the patient. Therapeutic inertia, defined as the failure by providers to increase therapy in the setting of identified poor blood pressure control, is also becoming a well-recognized barrier to achieving improved control rates . Thus, hypertension will likely remain the most common risk factor for heart attack and stroke . (See "Patient adherence and the treatment of hypertension".)
This topic provides a broad overview of the definitions, pathogenesis, complications, diagnosis, evaluation, and management of hypertension. Detailed discussions of all of these issues are found separately. The reader is directed, when necessary, to more detailed discussions of these issues in other topics.
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- Definitions based upon ambulatory and home readings
- White coat hypertension
- Masked hypertension
- Moderate to severe hypertensive retinopathy (formerly called "malignant hypertension")
- Hypertensive emergency
- Hypertensive urgency
- PRIMARY (ESSENTIAL) HYPERTENSION
- Risk factors for primary (essential) hypertension
- SECONDARY OR CONTRIBUTING CAUSES OF HYPERTENSION
- COMPLICATIONS OF HYPERTENSION
- DIAGNOSIS OF HYPERTENSION
- - Blood pressure measurement
- Home blood pressure monitoring
- Office-based blood pressure measurement
- Physical examination
- Laboratory testing
- Additional tests
- Testing for secondary hypertension
- Benefits of blood pressure control
- Who should be treated?
- Nonpharmacologic therapy
- Drug treatment
- - General efficacy
- - Initial monotherapy in uncomplicated hypertension
- - Combination therapy
- - Possible benefit from nocturnal therapy
- Goal blood pressure
- Resistant hypertension
- Discontinuing therapy
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS