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General Medicine

Hypertension, Essential

Ronald N. Adler, MD, FAAFP and Jeremy Golding, MD, FAAFP Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Essential hypertension (HTN) is HTN without an identifiable cause; it is also known as primary HTN and benign HTN. Although its importance as a risk factor for cardiovascular and oth...

DIAGNOSIS

Despite more aggressive guidelines issued by the ACC/AHA in 2017 (3)[C], many experts consider recommendations from JNC 8 to retain primacy. Critics of the ACC/AHA guidelines note multiple m...

TREATMENT

GENERAL MEASURES

  • The treatment discussed follows JNC 8 guidelines. More intensive therapy may be warranted for certain high-risk individuals (5)[B].

  • Individual treatment goals should be jointl...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Reevaluate patients q3–6mo until stable and then q6–12mo. Consider use of home self-BP monitoring; quality-of-life issues including sexual funct...

REFERENCES

1
James PA, Oparil S, Carter BL, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint Nationa...

SEE ALSO

Hypertension, Secondary and Resistant; Hypertensive Emergencies; Polycystic Kidney Disease 

CODES

ICD10

I10 Essential (primary) hypertension 

ICD9

  • 401.9 Unspecified essential hypertension

  • 401.1 Benign essential hypertension

SNOMED

  • 59621000 Essential hypertension (disorder)

  • 1201005 Benign essential ...

CLINICAL PEARLS

  • Treatment of HTN reduces risk of many serious medical conditions with NNT to prevent one serious MACE ranging from ~20 patients per year for severe HTN to more than several hundred per...

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Related Images
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Figure 12-21 Infantile polycystic kidney disease. Coronal image of a 24-week fetus demonstrates bilateral enlarged echogenic kidneys (arrows). Severe oligohydramnios is present.
Figure 12-21 Infantile polycystic kidney disease. Coronal image of a 24-week fetus demonstrates bilateral enlarged echogenic kidneys (arrow...
Figure 9.42. Polycystic kidney and liver disease. Frontal (A) and lateral (B) radiographs of an infant after IVU show the dense nephrogram appearance to the massively enlarged kidneys. The lucencies within the kidneys represent the cysts. C. CT image shows multiple cysts in the liver. D. CT image through the kidneys in an adult patient show multiple renal cysts. Notice the enhancement of the surro...
Figure 9.42. Polycystic kidney and liver disease. Frontal (A) and lateral (B) radiographs of an infant after IVU show the dense nephrogram ...
Figure 9.42. Polycystic kidney and liver disease. Frontal (A) and lateral (B) radiographs of an infant after IVU show the dense nephrogram appearance to the massively enlarged kidneys. The lucencies within the kidneys represent the cysts. C. CT image shows multiple cysts in the liver. D. CT image through the kidneys in an adult patient show multiple renal cysts. Notice the enhancement of the surro...
Figure 9.42. Polycystic kidney and liver disease. Frontal (A) and lateral (B) radiographs of an infant after IVU show the dense nephrogram ...
Figure 9.42. Polycystic kidney and liver disease. Frontal (A) and lateral (B) radiographs of an infant after IVU show the dense nephrogram appearance to the massively enlarged kidneys. The lucencies within the kidneys represent the cysts. C. CT image shows multiple cysts in the liver. D. CT image through the kidneys in an adult patient show multiple renal cysts. Notice the enhancement of the surro...
Figure 9.42. Polycystic kidney and liver disease. Frontal (A) and lateral (B) radiographs of an infant after IVU show the dense nephrogram ...
Figure 9.43. Polycystic kidney disease with renal failure. A. CT image shows multiple renal cysts. B. CT image through the pelvis shows a transplanted kidney (T).
Figure 9.43. Polycystic kidney disease with renal failure. A. CT image shows multiple renal cysts. B. CT image through the pelvis shows a t...
Figure 19-9 Hereditary polycystic kidney disease. Specimen from a 33-year-old man.
Figure 19-9 Hereditary polycystic kidney disease. Specimen from a 33-year-old man.
Infantile polycystic disease. The dilated cortical and medullary collecting ducts are arranged radially, and the external surface is smooth.
Infantile polycystic disease. The dilated cortical and medullary collecting ducts are arranged radially, and the external surface is smooth.
Fig CA 18-1 Essential (idiopathic) hypertension. (A) Frontal and (B) lateral views of the chest demonstrate characteristic tortuosity of the aorta (arrows), especially the ascending portion. Because the elevated blood pressure has caused left ventricular hypertrophy without dilatation, the radiographic appearance of the cardiac silhouette remains normal.
Fig CA 18-1 Essential (idiopathic) hypertension. (A) Frontal and (B) lateral views of the chest demonstrate characteristic tortuosity of th...
Fig CA 18-1 Essential (idiopathic) hypertension. (A) Frontal and (B) lateral views of the chest demonstrate characteristic tortuosity of the aorta (arrows), especially the ascending portion. Because the elevated blood pressure has caused left ventricular hypertrophy without dilatation, the radiographic appearance of the cardiac silhouette remains normal.
Fig CA 18-1 Essential (idiopathic) hypertension. (A) Frontal and (B) lateral views of the chest demonstrate characteristic tortuosity of th...
Fig GU 8-2. Adult polycystic kidney disease. Nephrogram phase from selective arteriography of the left kidney demonstrates innumerable cysts ranging from pinhead size to 2 cm. The opposite kidney had an identical appearance.6
Fig GU 8-2. Adult polycystic kidney disease. Nephrogram phase from selective arteriography of the left kidney demonstrates innumerable cyst...
Fig GU 28-2. Adult polycystic kidney disease. (A) Parasagittal sonogram of the right kidney (PK) shows a random distribution of multiple cysts that vary dramatically in size. The normal reniform contour is maintained. (B) Parasagittal sonogram in a young, asymptomatic member of the family shows multiple cysts (CR, CL) in the right kidney (R) and liver (L). (D, diaphragm; H, head.)2
Fig GU 28-2. Adult polycystic kidney disease. (A) Parasagittal sonogram of the right kidney (PK) shows a random distribution of multiple cy...
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