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Hypertension for PA

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Hypertension for the Physician Assistant Licensing Exam
Overview of Hypertension
Hypertension is defined as a blood pressure (BP) of ≥130/80 mm Hg, according to ACC/AHA guidelines, and is a major risk factor for cardiovascular, cerebrovascular, and renal disease.
arterial blood pressure
Classification
  • Normal: SBP <120 mm Hg and DBP <80 mm Hg
  • Elevated: SBP 120–129 mm Hg and DBP <80 mm Hg
  • Stage 1 Hypertension: SBP 130–139 mm Hg or DBP 80–89 mm Hg
  • Stage 2 Hypertension: SBP ≥140 mm Hg or DBP ≥90 mm Hg
Types of Hypertension
Primary (Essential) Hypertension
  • Definition: No identifiable cause, representing ~90% of cases.
  • Risk Factors: Family history, high salt intake, obesity, sedentary lifestyle, older age, and African American race.
Secondary Hypertension
  • Definition: Due to an identifiable cause, accounting for ~10% of cases.
  • Causes:
    • Renal Parenchymal Disease
    • Renovascular Disease: Renal artery stenosis
    • Endocrine Disorders: Hyperaldosteronism, pheochromocytoma
    • Medications: NSAIDs, oral contraceptives, corticosteroids
Diagnosis
  • Office BP Measurement: Use the average of two or more readings taken on two separate occasions.
  • Ambulatory BP Monitoring (ABPM): Useful for diagnosing white coat and masked hypertension.
  • Basic Laboratory Tests:
    • Electrolytes, BUN, Creatinine: Evaluate renal function.
    • Urinalysis: Detects proteinuria or hematuria.
    • Lipid Profile and Glucose: Screens for dyslipidemia and diabetes.
Management
Lifestyle Modifications
  • Weight Reduction: Each kilogram lost can reduce BP by ~1 mm Hg.
  • DASH Diet: Emphasizes fruits, vegetables, and low-fat dairy.
  • Sodium Restriction: Aim for <1500 mg/day.
  • Physical Activity: 90–150 minutes of aerobic exercise weekly.
Pharmacologic Therapy
  • First-Line Medications:
    • Thiazide Diuretics
    • ACE Inhibitors (ACEIs) / ARBs
    • Calcium Channel Blockers (CCBs)
  • Resistant Hypertension: BP ≥130/80 mm Hg despite three antihypertensives; consider an aldosterone antagonist.
Key Points
  • Hypertension Classification: Stage 1 starts at SBP 130–139 or DBP 80–89 mm Hg.
  • Diagnosis: Confirm with multiple readings; use ABPM for white coat hypertension.
  • Lifestyle Management: Essential for all patients, emphasizing DASH diet, weight loss, and sodium reduction.
  • Pharmacologic Therapy: Thiazides, ACEIs/ARBs, and CCBs are first-line agents.
  • Complications: Increases risk of cardiovascular disease, kidney disease, and stroke.
  • Emergencies:
    • Hypertensive Emergency: BP ≥180/120 mm Hg with end-organ damage, requiring IV therapy.
    • Hypertensive Urgency: BP ≥180/120 mm Hg without end-organ damage, managed with oral antihypertensives.

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