What Is Hypertension?
 

Hypertension is elevated blood pressure which causes an excess force of blood pushing against the arteries.

Why is it dangerous?

Uncontrolled hypertension can damage blood vessels and organs and increase the risk of:
 

• Heart attack

• Ischemic or Hemorrhagic Stroke

• Heart failure

• Kidney disease

• Vision loss

• Peripheral artery disease

• Aneurysm

• Vascular dementia

What Causes Hypertension?

Blood pressure is calculated by cardiac output x systemic vascular resistance. Therefore, these factors will raise one of these two components. 

Primary (essential) hypertension is influenced by ones polygenetic biological baseline and a combination of general factors including:
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• Aging

• Excess weight

• High-sodium diet

• Physical inactivity

• Diabetes

• Smoking

• Chronic inflammation

• Excess alcohol use

• Chronic stress

There are also secondary causes of hypertension. Secondary hypertension is commonly associated with resistant hypertension or with pediatric populations. 
 

• Renal Artery Stenosis

• Coarctation of the Aorta

• Medications (NSAIDs, corticosteroids, some antidepressants, stimulants, estrogen-containing birth control, and more)

• Thyroid and Parathyroid disorders

• Primary Aldosteronism (Conn’s Syndrome)

• Cushing's Syndrome

• Pheochromocytoma

• Obstructive Sleep Apnea

• Severe Kidney Diseases

How Is It Diagnosed?
 

• Multiple blood pressure measurements

• Home blood pressure readings and ambulatory readings

• History and physical
   

The American Heart Association (AHA) and American College of Cardiology (ACC) define hypertension as blood pressure that remains at or above 130/80 mmHg (for ages 13 and older), based on an average of at least two blood pressure measurements obtained on at least two separate occasions. At-home blood pressure monitoring is recommended to help confirm and monitor hypertension.

Children under age 13 are diagnosed using blood pressure thresholds based on age, sex, and height. Hypertension generally requires persistently elevated, auscultatory-confirmed readings at 3 separate visits. Stage 1 hypertension is defined as ≥95th percentile to <95th percentile + 12 mmHg, or 130/80–139/89 mmHg, whichever is lower. Stage 2 hypertension is ≥95th percentile + 12 mmHg, or ≥140/90 mmHg, whichever is lower, and requires more rapid evaluation and confirmation over 2 visits rather than 3. If the initial BP is elevated (≥90th percentile), 2 additional measurements using auscultation during that visit should be obtained and averaged. Ambulatory blood pressure monitoring is also recommended as an adjunct to confirm sustained hypertension in those under 13 years of age. 

Treatments
 

• Lifestyle changes (nutrition, exercise, stress management, etc.)

• Medication

• Addressing secondary causes

                      
When Is Medication Started?

Lifestyle changes are recommended for everyone with elevated blood pressure or hypertension.

Medication for adults is generally recommended for blood pressure averaging ≥140/90 mmHg, or at ≥130/80 mmHg in patients with cardiovascular disease, previous stroke, diabetes, chronic kidney disease, or a PREVENT 10-year CVD risk ≥7.5%. In lower-risk patients with stage 1 hypertension, lifestyle treatment may be tried first, with medication added if blood pressure remains elevated. Two medications may be started for stage 2 hypertension. The treatment goal is generally less than 130/80 mmHg. However, for people who are frail or have complex comorbidities, avoiding adverse effects may take precedence. 

In children under 13 years of age, stage 1 hypertension may initially be treated with lifestyle measures. Medication is recommended when hypertension persists despite lifestyle changes, or when hypertension occurs with diabetes, chronic kidney disease, target-organ damage such as left ventricular hypertrophy, or stage 2 hypertension. The treatment goal is generally <90th percentile.

                                                                Medications

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Thiazide and Thiazide-Like Diuretics - hydrochlorothiazide, chlorthalidone
 

Angiotensin-Converting Enzyme (ACE) Inhibitors - lisinopril, enalapril, benazepril
 

Angiotensin II Receptor Blockers (ARBs) - losartan, valsartan, olmesartan
 

Calcium Channel Blockers (CCBs) - amlodipine, nifedipine, diltiazem, verapamil
 

Beta Blockers - metoprolol, carvedilol, atenolol, propranolol
 

Mineralocorticoid Receptor Antagonists - spironolactone, eplerenone

Loop Diuretics - furosemide, torsemide
 

Alpha-1 Blockers - doxazosin, terazosin
 

Central Alpha-2 Adrenergic Agonists - clonidine, guanfacine, methyldopa
 

Direct Vasodilators - hydralazine

​Direct Renin Inhibitor - aliskiren

How to Accurately Take Your Blood Pressure

Take your blood pressure in the morning before eating or taking any blood pressure medication, and make sure that you have urinated. Also, take your blood pressure in the evening before dinner or before going to bed. 

To measure your blood pressure correctly, start by resting quietly for five minutes in a comfortable chair with your back supported, feet flat on the floor, and legs uncrossed. Ensure you have avoided caffeine, tobacco, food, and exercise for 30 minutes prior, and that your bladder is not full. Roll up your sleeve to place the cuff directly onto your bare arm, positioning it snugly just above the bend of your elbow, and rest your arm on a flat surface so the cuff sits at heart level. Remain completely still and silent while the machine takes the measurement. Take at least one more reading one minute after the first, and record both numbers along with the date and time. 

How Loria Mobile Medicine Can Help

I provide a cardiovascular disease risk assessment, screening, accurate diagnosis, medication management, and lifestyle counseling. I provide a thorough review of the different hypertensive medications, their benefits, and their side effects. I also provide education on current evidence-based hypertension guidelines, including recommendations from the American Heart Association (AHA) and American College of Cardiology (ACC), including recommended pathways for medication management and blood pressure goals.


                                                               References & Guidelines

• American Heart Association/American College of Cardiology et al. 2025 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

• American Academy of Pediatrics (AAP). Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.

• American Heart Association. 2025 High Blood Pressure Guideline: Top Things to Know.

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