Rabi DM, McBrien KA, Sapir-Pichhadze R, et al. Hypertension Canada's 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children. Can J Cardiol. 2020 May;36(5):596-624. doi: 10.1016/j.cjca.2020.02.086. PMID: 32389335.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulatio 2018 Oct 23; 138(17): e426-e483. doi: 10.1161/CIR.0000000000000597. PubMed PMID: 30354655.
Williams B, Mancia G, Spiering W, Agabiti Rosel E, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1; 29(33):3021-3104. doi: 10.1093/eurheartj/ehy339. PubMed PMID: 30165516.
Persu A, Giavarini A, Touzé E, et al; ESH Working Group Hypertension and the Kidney. European consensus on the diagnosis and management of fibromuscular dysplasia. J Hypertens. 2014 Jul;32(7):1367-78. doi: 10.1097/HJH.0000000000000213. Review. PubMed PMID: 24842696.
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National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. https://www.nice.org.uk/guidance/cg107. Published August 2010. Updated January 2011. Accessed March 22, 2017.
Classically hypertension was defined as a systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg. Blood pressure (BP) can be measured in a variety of ways: in a physician’s office by a manual sphygmomanometer or an automated oscillometric monitor (attended or unattended by a clinician, averaged over 3-6 measurements), or at home using either a 24-hour ambulatory blood pressure monitor or averaged home blood pressure readings done by the patient (2 measurements daily for 7 days). The numerous methods of measurements and their application to different populations generated numerous diagnostic thresholds, which may additionally differ slightly among professional bodies issuing recommendations. In general, the threshold for initiation of antihypertensive therapy is lowered by the presence of diabetes or BP-related target organ damage (cardiovascular, cerebrovascular, renal, or peripheral vascular disease, hypertensive retinopathy). It is also lowered when the automated office blood pressure (AOBP) method is used, as it provides slightly lower BP values than those measured by a clinician (non-AOBP). For example, according to Hypertension Canada’s 2020 guidelines, the diagnostic threshold for probable hypertension in patients with diabetes is based on manual in-office measurements with a cutoff value of 130/80 mm Hg. For those without diabetes the in-office diagnostic threshold is BP ≥140/90 mm Hg with a sphygmomanometer or ≥135/85 mm Hg with an automated office BP cuff. Diagnosis of hypertension should then be confirmed with home-based readings, either with a 24-hour ambulatory BP monitor (demonstrating a daytime mean ≥135/85 mm Hg or 24-hour mean ≥130/80 mm Hg) or with an ambulatory average BP cuff measurement of ≥135/85 mm Hg. Full guidelines are available on the Hypertension Canada website (guidelines.hypertension.ca); 2020-2022 Hypertension Highlights were also released.
Target blood pressure values: see Essential Hypertension.
Depending on etiology, hypertension is classified as:
1) Essential hypertension (>90% of cases).
2) Secondary hypertension.
Causes of secondary hypertension:
1) Kidney diseases:
a) Renal parenchymal diseases (see Renal Parenchymal Hypertension).
b) Renovascular diseases (see Renovascular Hypertension).
c) Renin-secreting tumors originating from the renal juxtaglomerular apparatus.
d) Primary sodium retention syndromes: Liddle syndrome, Gordon syndrome.
2) Endocrine diseases: Primary aldosteronism, Cushing syndrome, pheochromocytoma, thyrotoxicosis, hypothyroidism, hyperparathyroidism, carcinoid syndrome, acromegaly.
3) Coarctation of the aorta.
4) Preeclampsia or eclampsia (see Pregnancy-Related Hypertension).
5) Acute stress: Burns, alcohol withdrawal syndrome, psychogenic hyperventilation, hypoglycemia, major surgery.
6) Obstructive sleep apnea.
7) Increased intravascular fluid volume.
8) Diseases of the nervous system: Increased intracranial pressure, Guillain-Barré syndrome, quadriplegia, familial dysautonomia.
9) Drugs: Sympathomimetic agents, glucocorticoids, erythropoietin, nonsteroidal anti-inflammatory drugs, calcineurin inhibitors (cyclosporine [INN ciclosporin], tacrolimus), monoamine oxidase inhibitors, oral contraceptives, herbal drugs (eg, ginseng, yohimbine).
10) Toxic substances: Amphetamines, cocaine, heavy metals, alcohol, nicotine.
Causes of isolated systolic hypertension:
1) Increased stiffness of the aorta, most often in the elderly.
2) Conditions causing increased cardiac output: Aortic regurgitation, anemia, thyrotoxicosis, Paget disease, arteriovenous fistulas.
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