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Over one-third of adults in the United States aged 20 years and older have hypertension and over 40 million physician office visits with a primary diagnosis of hypertension occur each year. Total costs associated with high blood pressure in 2011 in the US were $46 billion in health care services, medications, and missed days of work.

Definition
JNC 8 guidelines: Goal blood pressure of SBP < 140 and DBP < 90 for all age groups and co-morbidities except age > 60. For age > 60, goal blood pressure is SBP < 150 and DBP < 90.

The SPRINT trial: Intensive blood pressure control (SBP < 120) improved CV outcomes and overall survival while modestly increasing the risk of some serious adverse events. [ Journal Club ] [ NEJM Trial Video ]

Hypertensive urgency
Hypertensive urgency is usually defined as SBP > 180 and DBP > 110 without symptoms. Asymptomatic hypertensive urgency does not require ED treatment.

Hypertensive emergency
Hypertensive emergency is defined as elevated blood pressure (SBP > 180, DBP >110) with evidence of end-organ damage (e.g. ACS, encephalopathy, ARF, PRES). This requires immediate treatment in the Emergency Department.

Rationale for Treatment
Every 5mm Hg increase in DBP and every 10mm Hg increase in SBP is associated with a 28% increase in the risk of death from coronary heart disease. A 10mm Hg drop in SBP and 5mm Hg drop in DBP was associated with 25% fall in cardiovascular disease, 25% reduction in CHF, and 33% reduction of strokes.

Essential hypertension
Etiology typically multifactoral: autonomic nervous system, the renin-angiontensin-aldosterone system, sodium-potassium ratios, and socioeconomic factors including stress.

Secondary hypertension
Common causes typically include known secondary causes such as chronic kidney disease, pheochromocytoma, hyperaldosteronism, hyperparathyroidism, drug-induced, as well as others

Other Pearls
Trial Summaries