chronic hypertension

Classification

see hypertension

Etiology

primary (essential) hypertension (risk factors)
- excessive dietary salt (see salt-sensitive HTN)
- excessive calorie intake
- stress
- African-American origin
- obesity
- family history of hypertension (see genetics)
- migraine or severe headaches (RR=1.25)^[157]
secondary hypertension
- renal parenchymal disease
- coarctation of the aorta
- alcohol increases early morning blood pressure surge
- smoking increases early morning blood pressure surge
- sleep deprivation^[49]^[50]
- sleep apnea^[51]
- occupational noise exposure^[126]
also see hypertension & etiology of arterial hypertension

Epidemiology

10-20% of persons age 25-45 years
30-40% of persons age 55-74 years
60% of persons > 65 years of age
African Americans
- have higher prevalence
- more aware of hypertension
- more likely to be treated for HTN
- less likely to be in good BP control^[55]
- Southern-style diet may contribute to higher risk of hypertension blacks^[138]
greatest contributor to cardiovascular disease worldwide^[4]
50% of patients with chronic hypertension are poorly controlled (BP > 140/90)^[4]
54% of strokes & 47% of ischemic heart disease can be attributed to chronic hypertension^[4]
> 25% of Medicare recipients to not adhere to antihypertensive regimens^[102]
blood pressure goals achieved in < 1/2 of patients who receive antihypertensive therapy^[120]
~1/2 of hypertension cases in middle-age & older adults in U.S., China, England, & India are concordant within heterosexual couples^[161]
- women married to men with hypertension are more likely to have hypertension themselves
- men married to women with hypertension are more likely to have hypertension themselves

Pathology

renal sympathetic hyperactivity
the renin angiotensin pathway is the major system influencing blood pressure
wide variability of blood pressure in hypertensive adults is associated with increased cardiovascular risk^[89]
also see blood pressure in the very old

Clinical manifestations

see hypertension
patients are generally asymptomatic
a single blood pressure reading is inadequate; multiple measurements are needed (5-6); combining home BP measurement with office-based measurements improves assessment^[46]

Laboratory

Diagnostic procedures

electrocardiogram:
- evidence of left ventricular hypertrophy suggests chronic hypertension
- left ventricular hypertrophy with normal blood pressure readings suggests masked hypertension^[4]
ambulatory blood pressure monitor
- goals: daytime systolic BP < 136 mm Hg; nighttime systolic BP < 125 mm Hg
- ambulatory BP monitoring is a better predictor of mortality than clinic-based measurements^[130]
- masked hypertension seems to have the worst prognosis^[130]
- Proof BP calculator suggested as a surrogate for ambulatory blood pressure monitor^[134]

Radiology

echocardiogram
- indications:
  - known heart disease
  - left bundle branch block on electrocardiogram
  - suspected white coat hypertension^[4]
  - electrocardiogram suggesting left ventricular hypertrophy^[4]

Complications

elevated systolic BP (> 140 mm Hg) & diastolic BP (> 90 mm Hg) independently predict risk for adverse cardiovascular events^[145]
- risk still elevated for threshold of > 130/80^[145]
increased risk of peripheral arterial disease (PAD)
- each 20 mm Hg increase in systolic BP & each 10 mm Hg increase in diastolic BP is associated with 63% & 35% higher risks for PAD^[93]
- peripheral arterial disease in turn is associated with a 50% increase in risk of cardiovascular events^[93]
increased risk of stroke*
- non-compliance with antihypertensive medications is associated with increased risk of stroke^[69]
- morning home systolic blood pressure >= 145 mm Hg associated with increased risk for stroke & for acute coronary syndrome relative to < 125 mm Hg^[99]
  - RR=6.0 for stroke & 6.2 for acute coronary syndrome comparing morning home systolic blood pressure >= 155 mm Hg vs < 125 mm Hg^[99]
early-onset hypertension confers greater cardiovascular risk than late-onset hypertension^[112]
- early-onset hypertension also is associated with excess risk of hypertension in offspring^[112]
- hypertension defined by ACC/AHA 2017 guidelines before age 40 confers risk for cardiovascular events later in life^[140]
greater BP variablity associated with increase risk of carotid atherosclerosis, white matter hyperintensities, stroke, & cognitive impairment in older patients^[72]
increased risk of chronic kidney disease
during midlife, increases risk of cognitive impairment in the elderly^[78]
children & adolescents (age 10-18 years) with untreated hypertension score lower on neurocognitive testing compared with normotensive controls, in particular, on measures of memory, attention, & executive functions^[103]

* treatment of stage 1 hypertension (BP=140-159/90-99 mm Hg) reduces cardiovascular risk & mortality (RR=0.7-0.8)^[84]

Management

a single blood pressure reading is inadequate; multiple measurements are needed (2-5);
- combining home BP measurement with office-based measurements improves assessment^[46]
- home BP measurement for self-titration of antihypertensives improves outcomes vs clinic-based BP measurement^[128]
- home BP measurement (digital) with automated prompts for medication changes^[150]
- note: goals of home systolic BP may be different than office-based measurements^[4]
goals of treatment
- reduce blood pressure to < 140/90 without adverse effects
  - same threshold applied to patients with diabetes mellitus or chronic renal failure^[74]^[116] (JNC8)
  - American College of Physicians recommends blood pressure < 130/80 for most patients, including those with chronic renal failure^[4]
  - American College of Cardiology/American Heart Association (ACC/AHA) recommends BP goal of < 130/80 mm Hg in most adults, including those with chronic kidney disease^[4]
  - American Diabetes Association 2018 recommends target BP of < 140/90 despite AHA/ACC guidelines^[116]
  - American Academy of Family Physicians recommends target BP of < 140/90 mm Hg despite AHA/ACC guidelines^[118]
  - preventive BP lowering is associated with reduced risk for cardiovascular death & if baseline systolic BP is >= 140 mm Hg^[113]
  - treatment not associated with benefit in primary prevention at lower systolic BP^[113]
  - antihypertensive treatment may not benefit patients with low cardiovascular risk & BP < 160/100^[139]
    - no benefit in mortality
    - higher risk for hypotension, syncope, electrolyte imbalance, & acute kidney injury^[139]
- for patients >= 60 years reduce blood pressure to < 150/90 without adverse effects^[74] (JNC 8)^[108] (ACP)
  - JNC 8 guidelines may allow more patients to achieve blood pressure goals^[83]
  - recommendations still < 140/90 for patients >= 60 with diabetes mellitus or chronic renal disease^[74]
- American College of Cardiology/American Heart Association (ACC/AHA) defines hypertension:
  - stage 1 hypertension: 130-139/80-89 mm Hg
  - stage 2 hypertension: 140-149/90-99 mm Hg
  - nonpharmacological interventions for stage 1 hypertension
    - add pharmacological intervention for 10-year risk of ASCVD >= 10%
  - add pharmacological intervention for stage 2 hypertension^[114]
  - evidence of lack of benefit & even harm^[113]
  - ACC/AHA fails to consider high pulse pressures in elderly & harms of low diastolic blood pressure^[121]
  - guideline hailed as 'robust prevention strategy' with benefits dwarfing risks^[131]
  - ACC/AHA guidelines would label ~2/3 of Americans 45-75 with hypertension^[132]
  - ACC/AHA guidelines not firmly rooted in evidence^[132]
  - an early drop in eGFR of > 15% with intensive treatment (< 4 months) is associated with increased risk of end-stage renal disease^[159]
  - intensive blood pressure control reduces risk of cardiovascular disease or all-cause mortality regardless of orthostatic hypotension^[160]
    - meta-analysis of 9 trials at least 1/2 of which used JNC8 guidelines^[160]
    - in patients with high cardiovascular risk, targeting systolic BP <120 mm Hg vs <140 mm Hg reduces major vascular events^[163]
- recommendations for patients with heart failure or coronary artery disease not found in JNC 8
  - target BP of < 140/90 mm Hg AHA/ACC/ASH in patients with coronary artery disease, including elderly^[48]^[85]
    - target BP of < 150/90 in elderly >= 80 with CAD^[88]
    - may be lower in some patients^[85]
    - authors recommend a minimum diastolic blood pressure of 60 mm Hg with a caveat that 70-75 mm Hg is generally considered safe^[85]^[88]
    - cognitive effects of lowering blood pressure not discussed^[85]^[88]
- goal may be to reduce left ventricular hypertrophy^[18]
- goal may be especially difficult to achieve in high-risk patients^[28]
- goal may be < 160/90 in elderly (> 80 years of age)
  - see blood pressure in the very old
  - risk of attempting to lower blood pressure in the frail elderly may exceed potential benefit^[4]
- use caution in treating systolic hypertension in patients with wide pulse pressure (see diastolic blood pressure)
- reducing the diastolic blood pressure below 70 mm Hg may increase cardiovascular events & all-cause mortality^[4]
- no obvious benefit of pharmacologic treatment in patients with mild hypertension (systolic BP = 140-159 mm Hg &/or diastolic BP = 90-99 mm Hg) in terms of total mortality or cardiovascular events at 5 years' follow-up^[52]
- systolic BP target of < 140 mm Hg reduces cardiovascular events, cardiovascular mortality & heart failure but not MI or stroke in persons > 65 years of age (from 4 'cherry-picked' trials)^[107]
  - may be increased risk of renal failure^[107]
- intensity of blood pressure control based on cardiovascular risk may improve cardiovascular outcomes^[80]^[94]^[146]
  - systolic blood pressure goal < 130 mm Hg^[94]
  - blood pressure lowering therapy for all patients with history of cardiovascular disease, coronary heart disease, stroke, diabetes mellitus, heart failure, or chronic kidney disease^[94]
  - more intensive systolic blood pressure control, target < 120 mm Hg vs 140 mm Hg for patients at high risk for heart disease or with kidney disease may reduce cardiovascular events & mortality^[90] (see SPRINT study)
  - two trials (ONTARGET & TRANSCEND trials) report that lowering systolic BP <120 mm Hg is associated with greater CV-related & all-cause mortality^[109]
  - target BP of < 130/80 mm Hg (AHA) in patients with coronary artery disease^[4]
  - target BP in patients with LVEF < 40% is < 120/80 (AHA)^[2]
  - average BP of 133/76 mm Hg reduces risk for MI, stroke, & albuminuria vs average BP of 140/81 (meta-analysis)^[91]
    - no difference in risk of heart failure, ESRD, or mortality
    - serious hypotensive events more common with more-intensive BP control (also see Notes: section)^[91]
    - benefits of intensive control may be greatest in patients with vascular disease, renal disease, or diabetes^[91]
  - target systolic blood pressure < 140 mmg Hg associated with higher cardiovascular mortality in patients with diabetes
- Blood Pressure Lowering Treatment Trialists' Collaboration meta-analysis concludes pharmacological blood pressure reduction is effective into old age, with no evidence that relative risk reductions for prevention of major cardiovascular events vary by systolic or diastolic blood pressure levels at randomisation, down to less than 120/70 mm Hg^[37]
  - the group analyzed their own data to support their conclusions
  - no discussion of diet or lifestyle changes, quality of life or cognition
  - no benefit found in elderly over 85 years
- a systematic review of blood pressure guidelines in the elderly^[155]
  - conclusions differ from ref^[37]
- prevent fluctuations in blood pressure^[72]
- minimize drug adverse effects
- an early drop in eGFR of > 15% with intensive treatment (< 4 months) is associated with increased risk of end-stage renal disease^[159]
strategy
- AHA,ACC, & CDC takes one size fits all approach^[73]
  - diet & lifestyle 1st line for stage 1 HTN & stage 2 HTN
    - diet & lifestyle should be part of any hypertension management strategy
    - overweight persons can reduce their need for antihypertensives within 4 months with diet & exercise^[136]
    - MKSAP19 suggests 3 month trial of diet & lifestyle - begin pharmaceutical treatment if - daytime ambulatory BP or home BP remains elevated > 130/80^[4] - evidence of masked hypertension & LVH^[4]
  - for stage 1 hypertension (140-159/90-99 (JNC8) 130-139/80-89 (AHA/ACC) mm Hg), start with single agent if known cardiovsascular disease or 10 year cardiovascular risk is > 10%^[4]
    - ACP uses AHA/ACC staging for hypertension, does not recognize JNC8^[4]
  - start with thiazide diuretic for stage 1 HTN
    - add ACE inhibitor or calcium channel blocker if needed
  - for diabetic with CKD3 or microalbuminuria, start with ACE inhibitor
    - add thiazide diuretic if needed
  - start with thiazide diuretic + ACE inhibitor for stage 2 HTN
    - two line antihypertensives for stage 2 HTN^[4]
  - calcium channel blocker may be used for stage 1 or stage 2 HTN
  - blacks: start with thiazide diuretic &/or calcium channel blocker^[4]
    - use calcium channel blocker + thiazide diuretic for combination therapy
    - amlodipine + HCTZ or perindopril slightly more effective than perindopril + HCTZ in blacks^[144]
  - initial therapy with once daily combination
    - telmisartan: 20 mg; amlodipine: 2.5 mg; chlorthalidone: 12.5 mg^[149]
- AHA updates recommendations for patients with CAD
  - patients with CAD, hypertension & stable angina should receive beta-blocker, ACE inhibitor, or thiazide diuretic^[88]
  - if beta-blockers are contraindicated, patients without LV systolic dysfunction can receive a nondihydropyridine calcium-channel blocker^[88]
- JNC 8^[74]
  - initial antihypertensive options include ACE inhibitor, ARB, calcium channel blocker or thiazide diuretic
  - in black population, initial therapy options include a thiazide diuretic or calcium channel blocker^[4]
    - use calcium channel blocker + thiazide diuretic for combination therapy
  - in patients with chronic renal failure, initial or add on therapy should include ACE inhibitor or ARB, but not both
- no benefit to anti-hypertensive agents for treatment of mild hypertension^[86]
- cardiovascular benefit to treating systolic hypertension depends on age & gender^[87]
- 1 in 12 patients experience adverse drug effects from antihypertensive agents^[86]
- 1/4 dose of 2 antihypertensives lowers blood pressure (6.7/4.4 mm Hg vs placebo) as effectively as standard-dose monotherapy^[111]
- BMI should not be a factor in selecting antihypertensive therapy^[82]
- nighttime hypertension may be associated increased risks for diabetes mellitus type 2, cardiovascular risk & heart failure
  - taking antihypertensives at bedtime may reduce these risks^[91]^[92]^[97]
  - findings not reproduced in a large, randomized trial in 2022^[97]
- team approaches are more effective than individual patient- level or provider-level interventions in reaching blood pressure goals^[120]
behavioral therapy
- involving patients in their own care improves BP control^[19]; may be sole therapy for Stage 1 hypertension if 10 year cardiovascular risk < 10%
- self-monitoring of blood pressure with self-titration of antihypertensives
  - more effective than usual care in managing blood pressure in high-risk patients^[81]
  - telemonitoring & self-titration of antihypertensives may improve BP control^[37]^[64]
- diet:
  - reduce salt^[34], fat, calories, increase fiber^[20] (see DASH diet);
    - GRS8 recommends HCTZ over DASH diet for systolic hypertension in elderly losing weight on current diet^[48] (see notes)
    - diet rich in whole grains reduces diastolic BP in obese & overweight adults^[104]
  - Mediterranean diet & DASH diet may have cardiovascular benefits
  - vegetable protein/vegetarian diet may lower BP a few mm Hg^[9]^[23]
  - K+ rich foods (3.5 g or 75 meq/day of K+) may be of some benefit in reducing risk of stroke^[5]
  - K+ (60-100 meq/day) decreases BP by 4.4/2.5 mm Hg (systolic/diastolic)^[9]
  - high dietary potassium is associated with lower blood pressure & a reduced risk of stroke in hypertensive patients^[60]
  - reducing consumption of sugar-sweetened beverages; average benefit ~ 2 mm Hg lower systolic BP^[36]
  - polyphenols in dark chocolate may be of some benefit
  - probiotics may help reduce blood pressure
    - 3.6 mm Hg systolic BP
    - 2.4 mm Hg diastolic BP^[79]
- aerobic exercise
  - may improve diastolic BP but not systolic BP in the elderly^[22]
  - stair climbing may reduce arterial stiffness & BP in postmenopausal women & improve leg strength^[123]
  - see exercise & blood pressure for effects of exercise on blood pressure
- weight reduction
- reduce alcohol intake to < 1 oz/day
  - alcohol in moderation may diminish all-cause mortality & cardiovascular mortality in hypertensive men^[14]
- smoking cessation - no effect on blood pressure but recommended for cardiovascular risk reduction
- sleeping in prone position lowers systolic blood pressure in men as much as 15 mm Hg^[21]
- culturally appropriate storytelling of benefit^[42]
- low-level tragus stimulation blocks sympathetic activity in young adults^[164]
  - 8 mm Hg reduction in systolic BP, 7 mm Hg reduction in diastolic BP^[164]
first line pharmacologic agents*#
- diuretics (thiazide)*
  - advantages
    - decrease in morbidity & mortality
    - may be essential for efficacy of other agents; counteracts reactive sodium retention
    - often effective in small doses with few side effects
    - effective in African-American individuals^[40]
    - low doses effective in elderly patients
- may diminish risk of hip fracture in elderly^[105]
  - - inexpensive
  - disadvantages
    - K+ & Mg+2 depletion
    - hyperuricemia
    - increase in LDL cholesterol
    - glucose intolerance & increased risk of diabetes^[24]
    - hypercalcemia^[4]
    - cost of monitoring & treating metabolic changes
- not effective in patients with GFR < 30 mL/min (use loop diuretic)^[4]
  - uncertainties
    - effect of coronary artery disease
    - use with coexisting diabetes
    - use with coexisting dyslipidemia
    - no proof that low-dose HCTZ (most commonly used antihypertensive) improves outcomes; at least 50 mg of HCTZ QD ... or chlorthalidone or indapamide used in trials that found improved outcomes^[44]
    - probably work best in patients with edema or volume overload^[53]
    - thiazides may be more cardioprotective in overweight than in lean patients^[58]
  - chlorthalidone more effective than HCTZ^[48]
  - loop diuretic may be needed if GFR < 30 mL/min/1.73 m2
- ACE inhibitors*
  - advantages
    - useful for patients with coexisting disorders: congestive heart failure (CHF); diabetic nephropathy post-MI systolic dysfunction
    - enhancement of insulin sensitivity
    - no effect of lipids
  - disadvantages
    - cough 5-15%
    - deterioration of renal function with reno-vascular disease
  - paraxodical pressure response may occur in patients with low plasma renin^[39]
- angiotensin II receptor antagonists (ARB)*
  - advantages
    - may reduce risk of ischemic stroke
    - reduced incidence of cough relative to ACE inhibitor
    - may allow cognitive protection through activation of angiotensin II receptor type 2 in the brain^[54] (ARBs block only type 1 receptors)
    - antihypertensives that stimulate vs inhibit type 2 & 4 angiotensin II receptors may result in a lower risk of dementia (see angiotensin II type 2 & 4 stimulating agent)
    - similar cardiovascular outcomes vs ACE inhibitors with fewer adverse effects^[153]
  - disadvantages:
    - may not benefit diabetic nephropathy
    - may not reduce mortality
  - ARBs potentiate adverse effects of ACE inhibitors,^[6] avoid combination
- calcium channel blockers*
  - advantages
    - reduction in morbidity & mortality in elderly men with systolic hypertension (dihydropyridines)
    - useful with coexisting angina
    - effective in African-Americans^[40]
    - effective with concomitant NSAID therapy
    - improvement in diastolic function
    - increase in renal blood flow
    - may be best agents for reducing risk of stroke^[32]
    - useful for cyclosporine-induced hypertension
    - may lower systolic BP variability more effectively than other classes of antihypertensives^[72]
  - disadvantages
    - peripheral edema
    - headache
    - may exacerbate systolic dysfunction (except vasoactive dihydropyridines)
    - short acting nifedipine: negative inotropic effect; may produce marked hypotension; reflex increase in sympathetic activity
  - avoid short-acting calcium channel blockers
  - only diltiazem & verapamil block the AV node
alternative agents
- centrally acting alpha-adrenergic agonists
  - clonidine
  - alpha methyl dopa
- alpha-adrenergic antagonists
  - doxazosin (Cardura)
  - terazosin (Hytrin)
  - advantages
    - improvement in lipid profile
    - enhancement of insulin sensitivity
    - usefulness with coexisting prostatic hypertrophy
  - disadvantages
    - tachycardia
    - orthostatic hypotension, especially after 1st dose
    - increased mortality in ALLHAT study
- beta-adrenergic receptor blockers (beta-blocker)^[27]
  - not 1st line for uncomplicated hypertension
  - less effective in blacks than in whites & south Asians^[39]
  - advantages
    - decrease in morbidity & mortality in younger patients
    - improves survival after myocardial infarction
    - useful for patients with coexisting angina
    - useful for patients with coexisting migraine
    - may be best agents for reducing risk of recurrent MI^[32]
  - disadvantages
    - decreases HDL cholesterol
    - increased insulin resistance & risk of diabetes^[24]
    - decreased exercise tolerance
    - contraindicated in patients with coexisting asthma
    - may exacerbate chronic bronchitis (COPD)
    - may exacerbate coexisting peripheral vascular disease (PVD)
    - may be less effective in the elderly^[25]
    - unopposed alpha-adrenergic activity (elevated in the elderly)
    - paradoxical pressor response may occur in patients with low plasma renin^[39]
  - uncertainties
    - effect on coronary artery disease
    - safety with coexisting diabetes mellitus: beta blockers may mask symptoms of hypoglycemia
    - safety with coexisting dyslipidemia
drug combinations
- more often than not two or more agents are needed^[11]^[16]
- starting with combination therapy may be superior to starting with monotherapy^[41]
- if systolic blood pressure reduction of >= 20 mm Hg needed to reach target BP or stage 2 hypertension, combination therapy indicated^[4]
- 3 low-dose antihypertensives more likely to achieve BP target than fewer but higher dose antihypertensives^[135]
  - with 3 drugs, include a diuretic to prevent edema^[40]
- 4 low dose antihypertensives more likely to achieve BP target than maximum single-dose irbesartan^[152]
  - 37.5 mg irbesartan, 1.25 mg amlodipine, 0.625 mg indapamide, 2.5-mg bisoprolol
- addition of antihypertensive from a new class may lower systolic BP & cardiovascular risk^[137]
- adding a new medication is associated with better blood pressure control than maximizing a current medication^[154]
- combinations of choice^[38]
  - ACE inhibitor plus thiazide diuretic
    - chlorthalidone more effective than HCTZ^[48]
    - diuretic enhances antihypertensive effect & mitigates hyperkalemic effect of ACE inhibitor
    - combination pill once a day improves compliance with HEDIS measure (BP < 140/90)^[71]
    - loop diuretic may be needed if GFR < 30 mL/min/1.73 m2
  - ACE inhibitor plus dihydropyridine Ca+2 channel blocker (amlodipine, felodipine, nifedipine ...)
    - ACE inhibitor plus calcium channel blocker was better than ACE inhibitor plus diuretic in slowing progression of nephropathy in ACCOMPLISH trial^[68]
    - amlodipine plus perindopril less effective in blacks than in whites & south Asians^[39]
  - angiotensin receptor blocker (ARB) plus thiazide diuretic
  - angiotensin receptor blocker (ARB) plus dihydropyridine Ca+2 channel blocker (CCB)
    - moderate-dose ARB plus Ca+2 channel blocker may be superior to high-dose ARB monotherapy, especially in patients with cardiovascular disease or renal disease^[57]
  - amlodipine/indapamide/telmisartan^[166] (may be combination of choice)
- alternative combinations^[38]
  - Ca+2 channel blocker plus thiazide diuretic
  - thiazide diuretic plus potassium-sparing diuretic
  - Aliskiren plus thiazide diuretic or CCB
  - beta-blocker plus diuretic or dihydropyridine CCB
- combinations to avoid^[38]
  - ACE inhibitor plus angiotensin receptor blocker (ARB)
  - beta-blocker plus verapamil or diltiazem
  - beta-blocker plus central-acting alpha agonist (clonidine, etc)
drug indications with comorbid & specific conditions
- diabetes mellitus (DM)
  - ACE inhibitors
  - angiotensin II receptor antagonists
  - effects of ACE inhibitors & ARBs may be additive
  - calcium channel blockers
    - verapamil & diltiazem appear to prevent diabetic nephropathy
    - nifedipine may increase proteinuria
  - target BP for patients with DM is < 130/80
- heart failure
  - ACE inhibitor
  - carvedilol or other beta-blocker
  - add diuretic as needed
  - hydralazine plus isordil (BiDil 1-2 tabs PO TID)
    - an adjunct to standard therapy in blacks^[4]^[66]
    - add to ACE inhibitor, beta-blocker & diuretic in black patients with NYC class 3 or 4 heart failure
- isolated systolic hypertension
  - Maxzide, HCTZ or other thiazide diuretic
  - calcium channel blocker
- myocardial infarction with systolic dysfunction
  - beta-blocker
  - ACE inhibitor
- coronary artery disease (CAD)
  - beta-blocker
  - calcium channel blocker (risk of CAD)^[48]
- atrial tachycardia/fibrillation
  - calcium channel blocker
  - beta-blocker
- cyclosporine-induced hypertension
  - calcium channel blocker
- dyslipidemia - prazosin
- essential tremor - propranolol
- hyperthyroidism - propranolol
- migraine
  - propranolol
  - metoprolol
- osteoporosis - thiazide diuretic (HCTZ, chlorthalidone)
- pre-operative hypertension - atenolol
- benign prostatic hypertrophy - prazosin
- renal insufficiency - ACE inhibitor or ARB
  - see hemodialysis for treatment of hypertension in dialysis patients
- elderly (see blood pressure in the very old)
  - control of isolated systolic hypertension
  - low-dose diuretic
- blacks (high prevalence of salt-sensitive hypertension)
  - diuretics
    - thiazide plus ACE inhibitor^[4]
    - chlorthalidone more effective than HCTZ^[48]
  - calcium channel blockers^[24]
  - all agents are effective
- pregnancy
  - alpha-methyl dopa (Aldomet)
  - hydralazine
  - diuretics, alpha-blockers & calcium channel blockers may be continued if prescribed prior to conception
- gout
  - losartan (unique among ARBS) has uricosuric effect^[57]
  - calcium channel blockers also lower serum uric acid
no age-specific antihypertensive selection guidelines^[30] see^[35] for dosing of antihypertensives in children
see antihypertensive agent for number needed to treat
taking medications in AM results in better compliance than taking them in PM (see medication compliance)
- younger age, female gender, more prescribed medications, & prescription of a diuretic reduces medication compliance]^[110]
surgery for resistant hypertension
- renal sympathetic denervation^[31]
  - fails to lower systolic BP by > 10 mm Hg^[31]
alternative therapies that may be beneficial
- breathing entrainment device (RespErate)
- Tai Chi
- CoQ10 100-200 mg/day^[9]^[47]
- dark chocolate^[9] (see diet above)
therapies without proven benefit:
- calcium, magnesium, garlic, fish oil
- biofeedback^[75]
- soy may improve systolic & diastolic blood pressure in patients with hypertension*^[4]^[26] (benefit < 15 mm Hg)
pay for performance does not benefit patients^[43]
pharmacists in black barbershops in connection with health promotion by barbers may help reduce uncontrolled hypertension^[125]^[141]
pharmacist-led telehealth as effective as clinic-based control of managing chronic hypertension^[156]
follow-up
- every 6 months equivalent to every 3 months for stable, controlled hypertension^[14]

Guidelines from Joint National Committee on High Blood Pressure

* Joint National Committee recommends thiazide diuretic as preferred 1st line agent. A second agent is selected in accord with comormid conditions.^[16]

* diuretic 1st line^[147]

* USPSTF recommends a thiazide, calcium channel blocker, ACE inhibitor or ARB 1st line in non-black patients

* USPSTF recommends a thiazide or calcium channel blocker as 1st line in black patients

* 23-year mortality same for ACE-inhibitor, calcium channel blocker, diuretic^[162]

# most patients need at least 2 agents to control hypertension^[11]^[16]; single pill once a day improves compliance^[71]

Notes

GRS8 recommends HCTZ over DASH diet for systolic hypertension in elderly losing weight on current diet^[48], even if patient does not like the food they are losing weight on^[48]
GRS8 cites HVET study (funded by manufacturer of study drugs) to support choice of HCTZ although:
- patient not member of study population
- indapamide not HCTZ was diuretic in HVET study
meta-analysis of 19 trials concludes average BP of 133/76 mm Hg reduces risk of major cardiovascular events 14% vs average BP of 140/81^[91]
- risk reduction for MI, stroke, & albuminuria
- no difference in risk of heart failure, ESRD, or mortality
- serious hypotensive events more common with more-intensive BP control
- benefits of intensive control greatest in trials limited to patients with vascular disease, renal disease, or diabetes
- authors say serious hypotensive events likely would not outweigh benefits in high-risk patients
- no discussion of effects on cognition noted^[91]
a systolic BP consistently > 120-125 mm Hg may signal incipient chronic hypertension^[124]

More general terms

More specific terms

Additional terms

References

↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39, 340-346
↑ ^2.0 ^2.1 Yusuf S et al for the ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008, 358:1547 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18378520
↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 65-84
↑ ^4.00 ^4.01 ^4.02 ^4.03 ^4.04 ^4.05 ^4.06 ^4.07 ^4.08 ^4.09 ^4.10 ^4.11 ^4.12 ^4.13 ^4.14 ^4.15 ^4.16 ^4.17 ^4.18 ^4.19 ^4.20 ^4.21 ^4.22 ^4.23 ^4.24 ^4.25 ^4.26 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
↑ ^5.0 ^5.1 Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 220-221
↑ ^6.0 ^6.1 Journal Watch 21(3):21, 2001 Mogensen et al Randomised controlled trial of dual blockade of renin- angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 321:1440, 2000 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11110735
Phillips CO, Kashani A, Ko DK, Francis G, Krumholz HM. Adverse effects of combination angiotensin II receptor blockers plus angiotensin-converting enzyme inhibitors for left ventricular dysfunction: a quantitative review of data from randomized clinical trials. Arch Intern Med. 2007 Oct 8;167(18):1930-6. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17923591
↑ Journal Watch 22(8):61, 2002 Oliveria SA et al Physician-related barriers to the effective management of uncontrolled hypertension. Arch Intern Med 162:413, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11863473
↑ Journal Watch 22(8):61, 2002 Boutitie F et al J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data. Ann Intern Med 136:438, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11900496
↑ ^9.0 ^9.1 ^9.2 ^9.3 ^9.4 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004; 7th edition 2010
↑ Prescriber's Letter 10(1):1 2003
↑ ^11.0 ^11.1 ^11.2 Prescriber's Letter 10(4):19 2003
↑ Journal Watch 24(1):5, 2004 Chobanian AV et al The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 289:2560, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12748199
↑ Chobanian AV et al Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42:1206, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14656957
↑ ^14.0 ^14.1 ^14.2 Journal Watch 24(6):50, 2004 Birtwhistle RV et al Randomised equivalence trial comparing three month and six month follow up of patients with hypertension by family practitioners. BMJ 328:204, 2004 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/14726370 <Internet> http://bmj.bmjjournals.com/cgi/content/full/328/7433/204
↑ Malinski MK, Sesso HD, Lopez-Jimenez F, Buring JE, Gaziano JM. Alcohol consumption and cardiovascular disease mortality in hypertensive men. Arch Intern Med. 2004 Mar 22;164(6):623-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15037490
↑ ^16.0 ^16.1 ^16.2 ^16.3 Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Hypertension. 2003 Dec;42(6):1206-52. Epub 2003 Dec 01 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14656957
↑ Journal Watch 23(10):78, 2003 Berl T et al Cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial of patients with type 2 diabetes and overt nephropathy. Ann Intern Med 138(Apr 1):542, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12667024
Snow V et al The Evidence Base for Tight Blood Pressure Control in the Management of Type 2 Diabetes Mellitus Ann Intern Med 138:587, 2003 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/12667031 <Internet> http://www.annals.org/issues/v138n7/full/200304010-00017.html
Vijan S & Hayward RA Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice of agents, and setting priorities in diabetes care. Ann Intern Med 138:593, 2003 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/12667032 <Internet> http://www.annals.org/issues/v138n7/full/200304010-00018.html
↑ ^18.0 ^18.1 Journal Watch 25(1):1, 2005 Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, Snapinn S, Harris KE, Aurup P, Edelman JM, Wedel H, Lindholm LH, Dahlof B; LIFE Study Investigators. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events. JAMA. 2004 Nov 17;292(19):2343-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15547161
Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen MS, Papademetriou V, Rokkedal J, Harris K, Aurup P, Dahlof B. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA. 2004 Nov 17;292(19):2350-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15547162
↑ ^19.0 ^19.1 Roumie CK+L et al, Improving blood pressure control through provider education, provider allerts, and patient education: A cluster randomized trial. Ann Intern Med 2006, 145:165 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16880458
↑ ^20.0 ^20.1 Whelton SP, Hyre AD, Pedersen B, Yi Y, Whelton PK, He J. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J Hypertens. 2005 Mar;23(3):475-81. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15716684
↑ ^21.0 ^21.1 Tabara Y, American Heart Association Conference, Chicago, 2004
↑ ^22.0 ^22.1 Stewart KJ, Bacher AC, Turner KL Effect of exercise on blood pressure in older persons: a randomized controlled trial Archives of Internal Medicine 165:756, 2005 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15824294
↑ ^23.0 ^23.1 Elliott P, Stamler J, Dyer AR, Appel L, Dennis B, Kesteloot H, Ueshima H, Okayama A, Chan Q, Garside DB, Zhou B. Association between protein intake and blood pressure: the INTERMAP Study. Arch Intern Med. 2006 Jan 9;166(1):79-87. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16401814
↑ ^24.0 ^24.1 ^24.2 ^24.3 Elliot WJ and Meyer PM Incident diabetes in clinical trials of antihypertensive drugs: A network meta-analysis. Lancet 2007, 369:201 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17240286
↑ ^25.0 ^25.1 Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis. CMAJ. 2006 Jun 6;174(12):1737-42. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16754904
↑ ^26.0 ^26.1 Welty FK, Effect of soy nuts on blood pressure and lipie levels in hypertensive, prehypertensive, and normotensive postmenopausal women. Arch Intern Med 2007, 167:1060 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17533209
↑ ^27.0 ^27.1 Prescriber's Letter 14(8): 2007 CHART: AHA Blood Pressure Goals and Treatments Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230801&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^28.0 ^28.1 Wong ND et al, Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003-2004. Arch Intern Med 2007, 167:2431 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18071164
↑ Prescriber's Letter 15(6): 2008 Resistant Hypertension Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240611&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^30.0 ^30.1 Turnball F et al, for the Blood Pressure Lowering Treatment Trialists' Collaboration Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: Meta-analysis of randomised trials. BMJ 2008, 336:1121 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18480116
↑ ^31.0 ^31.1 ^31.2 Krum H et al. Catheter-based renal sympathetic denervation for resistant hypertension: A multicentre safety and proof-of-principle cohort study. Lancet 2009 Mar 30; [e-pub ahead of print] <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19332353 <Internet> http://dx.doi.org/10.1016/S0140-6736(09)60566-3
Doumas M and Douma S. Interventional management of resistant hypertension. Lancet 2009 Mar 30; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19332354 <Internet> http://dx.doi.org/10.1016/S0140-6736(09)60624-3
Symplicity HTN-2 Investigators Renal sympathetic denervation in patients with treatment- resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 2010 Dec 4; 376:1903 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21093036 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62039-9/fulltext
Doumas M, Douma S. Renal sympathetic denervation: the jury is still out. Lancet 2010 Dec 4; 376:1878 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21093037
Brandt MC et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol 2012 Mar 6; 59:901. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22381425
Zile MR and Little WC. Effects of autonomic modulation: More than just blood pressure. J Am Coll Cardiol 2012 Mar 6; 59:910. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22381426
Krum H et al. Percutaneous renal denervation in patients with treatment- resistant hypertension: Final 3-year report of the Symplicity HTN-1 study. Lancet 2013 Nov 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24210779
ClinicalTrials.gov Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN-3) http://clinicaltrials.gov/ct2/show/record/NCT01418261
Meditronic News Release. Jan 9, 2014 Medtronic Announces U.S. Renal Denervation Pivotal Trial Fails to Meet Primary Efficacy Endpoint While Meeting Primary Safety Endpoint. http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=1889335&highlight=
↑ ^32.0 ^32.1 ^32.2 Law MR et al
Use of blood pressure lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009 May 19; 338:b1665 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19454737 <Internet> http://dx.doi.org/10.1136/bmj.b1665
↑ Verdecchia P et al Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): An open-label randomised trial. Lancet 2009 Aug 15; 374:525. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19683638
↑ ^34.0 ^34.1 Pimenta E et al Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: Results from a randomized trial. Hypertension 2009 Sep; 54:475 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19620517
↑ ^35.0 ^35.1 Prescriber's Letter 16(12): 2009 Dosing Antihypertensive Meds in Kids CHART: Dosing Antihypertensive Meds in Kids GUIDELINES: Diagnosis and Treatment of Hypertension in Children and Adolescents (NIH) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=251211&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^36.0 ^36.1 Chen L et al Reducing Consumption of Sugar-Sweetened Beverages Is Associated With Reduced Blood Pressure. A Prospective Study Among United States Adults Circulation. 2010, Published online May 24, 2010 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20497980 <Internet> http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.109.911164v1
↑ ^37.0 ^37.1 ^37.2 ^37.3 McManus RJ et al, Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial The Lancet, Early Online Publication, 8 July 2010 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20619448 doi:10.1016/S0140-6736(10)60964-6 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60964-6/fulltext
Ogedegbe G Self-titration for treatment of uncomplicated hypertension The Lancet, Early Online Publication, 8 July 2010 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20619449 doi:10.1016/S0140-6736(10)61050-1 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61050-1/fulltext
↑ ^38.0 ^38.1 ^38.2 ^38.3 Prescriber's Letter 17(10): 2010 COMMENTARY: Combination Therapy for Hypertension CHART: Antihypertensive Combinations PATIENT HANDOUT: Blood Pressure Medications and You PATIENT HANDOUT SPANISH VERSION: Sus Medicamentos Para La Presin Arterial GUIDELINES: Combination Therapy in Hypertension Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=261001&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^39.0 ^39.1 ^39.2 ^39.3 ^39.4 Turner ST et al Plasma renin activity predicts blood pressure responses to beta-blocker and thiazide diuretic as monotherapy and add-on therapy for hypertension. Am J Hypertens 2010 Sep; 23:1014 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20725057
Alderman MH et al. Pressor responses to antihypertensive drug types. Am J Hypertens 2010 Sep; 23:1031 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20725055
Gupta AK et al on behalf of ASCOT investigators. Ethnic differences in blood pressure response to first and second-line antihypertensive therapies in patients randomized in the ASCOT trial. Am J Hypertens 2010 Sep; 23:1023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20725056
Brown MJ. Heterogeneity of blood pressure response to therapy. Am J Hypertens 2010 Sep; 23:926. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20733564
Furberg CD. Renin-guided treatment of hypertension: Time for action. Am J Hypertens 2010 Sep; 23:929. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20733565
↑ ^40.0 ^40.1 ^40.2 ^40.3 Prescriber's Letter 17(12): 2010 COMMENTARY: Hypertension Treatment in African American Patients Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=261210&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^41.0 ^41.1 Brown MJ et al Aliskiren and the calcium channel blocker amlodipine combination as an initial treatment strategy for hypertension control (ACCELERATE): a randomised, parallel-group trial Lancet. 2011 Jan 22;377(9762):312-20. Epub 2011 Jan 12. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21236483 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62003-X/fulltext
↑ ^42.0 ^42.1 Houston TK et al Culturally appropriate storytelling to improve blood pressure: A randomized trial. Ann Intern Med 2011 Jan 18; 154:77. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21242364
↑ ^43.0 ^43.1 Serumaga B et al. Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: Interrupted time series study. BMJ 2011 Jan 25; 342:d108 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21266440
↑ ^44.0 ^44.1 Prescriber's Letter 18(3): 2011 COMMENTARY: Thiazides for Hypertension CHART: Comparison of Commonly Used Diuretics Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270304&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ Aronow WS et al, ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents J Am Coll Cardiol. 2011 Apr 15. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21524875 <Internet> http://content.onlinejacc.org/cgi/reprint/j.jacc.2011.01.008v1.pdf
↑ ^46.0 ^46.1 ^46.2 Powers BJ et al Measuring Blood Pressure for Decision Making and Quality Reporting: Where and How Many Measures? Annals of Internal Medicine: June 20, 2011 154(12):781-788 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21690592 <Internet> http://www.annals.org/content/154/12/781.full.pdf+html
Appel LJ et al Improving the Measurement of Blood Pressure: Is It Time for Regulated Standards? Annals of Internal Medicine: June 20, 2011 154(12):838-39 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21690599 <Internet> http://www.annals.org/content/154/12/838.extract
↑ ^47.0 ^47.1 Rosenfeldt F et al Systematic review of effect of coenzyme Q10 in physical exercise, hypertension and heart failure. Biofactors. 2003;18(1-4):91-100. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14695924
↑ ^48.0 ^48.1 ^48.2 ^48.3 ^48.4 ^48.5 ^48.6 ^48.7 ^48.8 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
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↑ ^50.0 ^50.1 Knutson KL et al Association Between Sleep and Blood Pressure in Midlife The CARDIA Sleep Study Arch Intern Med. 2009;169(11):1055-1061 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19506175
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↑ ^53.0 ^53.1 Weber MA et al Effects of body size and hypertension treatments on cardiovascular event rates: subanalysis of the ACCOMPLISH randomised controlled trial. The Lancet, Early Online Publication, 6 December 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23219284 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61343-9/abstract
↑ ^54.0 ^54.1 Hajjar I et al Effect of antihypertensive therapy on cognitive function in early executive cognitive impairment: a double-blind randomized clinical trial. Arch Intern Med. 2012 Mar 12;172(5):442-4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22412114
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↑ Choi HK, Soriano LC, Zhang Y, Rodriguez LA. Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study. BMJ 2012; 344:d8190 PMID: https://www.ncbi.nlm.nih.gov/pubmed/2224011
↑ ^57.0 ^57.1 ^57.2 Ogawa H et al. Angiotensin II receptor blocker-based therapy in Japanese elderly, high-risk, hypertensive patients. Am J Med 2012 Oct; 125:981. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22503610
Kim-Mitsuyama S et al. An angiotensin II receptor blocker-calcium channel blocker combination prevents cardiovascular events in elderly high-risk hypertensive patients with chronic kidney disease better than high-dose angiotensin II receptor blocker alone. Kidney Int 2013 Jan; 83:167. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23051740
↑ ^58.0 ^58.1 Weber MA et al. Effects of body size and hypertension treatments on cardiovascular event rates: Subanalysis of the ACCOMPLISH randomised controlled trial. Lancet 2013 Feb 16; 381:537 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23219284
Messerli FH and Bangalore S. Diuretic-based regimens for obese patients? Lancet 2013 Feb 16; 381:512. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23219285
↑ Prescriber's Letter 20(4): 2013 Evidence-Based Strategies for Managing Hypertension and Dyslipidemia. Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=290421&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^60.0 ^60.1 Aburto NJ et al. Effect of increased potassium intake on cardiovascular risk factors and disease: Systematic review and meta-analyses. BMJ 2013 Apr 4; 346:f1378. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23558164
↑ Rosendorff C, Black HR, Cannon CP et al Treatment of hypertension in the prevention and management of ischemic heart disease: a scientific statement from the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention. Circulation. 2007 May 29;115(21):2761-88 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17502569
↑ American College of Physicians. In the clinic. Hypertension. Ann Intern Med. 2008 Dec 2;149(11):ITC6(1-15). PMID: https://www.ncbi.nlm.nih.gov/pubmed/19047024
↑ Sarafidis PA, Bakris GL. Resistant hypertension: an overview of evaluation and treatment. J Am Coll Cardiol. 2008 Nov 25;52(22):1749-57. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19022154
↑ ^64.0 ^64.1 McKinstry B et al. Telemonitoring based service redesign for the management of uncontrolled hypertension: Multicentre randomised controlled trial. BMJ 2013 May 24; 346:f3030 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23709583
↑ Ernst ME, Gordon JA. Diuretic therapy: key aspects in hypertension and renal disease. J Nephrol. 2010 Sep-Oct;23(5):487-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20677164
↑ ^66.0 ^66.1 Flack JM, Sica DA, Bakris G, Brown AL et al Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. 2010 Nov;56(5):780-800 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20921433
↑ Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010 May 26;303(20):2043-50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20501926
↑ ^68.0 ^68.1 Bakris GL, Sarafidis PA, Weir MR et al Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial. Lancet. 2010 Apr 3;375(9721):1173-81. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20170948
↑ ^69.0 ^69.1 Herttua K et al Adherence to antihypertensive therapy prior to the first presentation of stroke in hypertensive adults: population- based study. Eur Heart J. July 16, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23861328 <Internet> http://eurheartj.oxfordjournals.org/content/early/2013/07/09/eurheartj.eht219.abstract
↑ Mancia G et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013 Jun 14 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23771844 <Internet> http://eurheartj.oxfordjournals.org/content/34/28/2159
↑ ^71.0 ^71.1 ^71.2 Jaffe MG et al Improved Blood Pressure Control Associated With a Large-Scale Hypertension Program. JAMA. 2013;310(7):699-705 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23989679 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1730511
Goyal A and Bornstein WA Health System - Wide Quality Programs to Improve Blood Pressure Control. JAMA. 2013;310(7):695-696 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23989806 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1730495
↑ ^72.0 ^72.1 ^72.2 ^72.3 Sabayan B et al. Association of visit-to-visit variability in blood pressure with cognitive function in old age: Prospective cohort study. BMJ 2013 Jul 30; 347:f4600 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23900315 <Internet> http://www.bmj.com/content/347/bmj.f4600?ijkey=0bd340e53dee6e98694626975fbf9f474815ce8a&keytype2=tf_ipsecsha
Webb AJS Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. The Lancet. 2010 375:906-915 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20226989 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60235-8/fulltext
↑ ^73.0 ^73.1 Go AS et al An effective Approach to High Blood Pressure Control A Science Advisory From the American Heart Association, the American College of Cardiology and the Centers for Disease Control and Prevention. Hypertension. Nov 15, 2013 http://hyper.ahajournals.org/content/early/2013/11/14/HYP.0000000000000003
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Patient information

chronic hypertension patient information

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Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen MS, Papademetriou V, Rokkedal J, Harris K, Aurup P, Dahlof B. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA. 2004 Nov 17;292(19):2350-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15547162

[ref19-19] 19.0 ^19.1 Roumie CK+L et al, Improving blood pressure control through provider education, provider allerts, and patient education: A cluster randomized trial. Ann Intern Med 2006, 145:165 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16880458

[ref20-20] 20.0 ^20.1 Whelton SP, Hyre AD, Pedersen B, Yi Y, Whelton PK, He J. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J Hypertens. 2005 Mar;23(3):475-81. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15716684

[ref21-21] 21.0 ^21.1 Tabara Y, American Heart Association Conference, Chicago, 2004

[ref22-22] 22.0 ^22.1 Stewart KJ, Bacher AC, Turner KL Effect of exercise on blood pressure in older persons: a randomized controlled trial Archives of Internal Medicine 165:756, 2005 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15824294

[ref23-23] 23.0 ^23.1 Elliott P, Stamler J, Dyer AR, Appel L, Dennis B, Kesteloot H, Ueshima H, Okayama A, Chan Q, Garside DB, Zhou B. Association between protein intake and blood pressure: the INTERMAP Study. Arch Intern Med. 2006 Jan 9;166(1):79-87. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16401814

[ref24-24] 24.0 ^24.1 ^24.2 ^24.3 Elliot WJ and Meyer PM Incident diabetes in clinical trials of antihypertensive drugs: A network meta-analysis. Lancet 2007, 369:201 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17240286

[ref25-25] 25.0 ^25.1 Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis. CMAJ. 2006 Jun 6;174(12):1737-42. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16754904

[ref26-26] 26.0 ^26.1 Welty FK, Effect of soy nuts on blood pressure and lipie levels in hypertensive, prehypertensive, and normotensive postmenopausal women. Arch Intern Med 2007, 167:1060 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17533209

[ref27-27] 27.0 ^27.1 Prescriber's Letter 14(8): 2007 CHART: AHA Blood Pressure Goals and Treatments Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230801&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref28-28] 28.0 ^28.1 Wong ND et al, Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003-2004. Arch Intern Med 2007, 167:2431 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18071164

[ref29-29] Prescriber's Letter 15(6): 2008 Resistant Hypertension Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240611&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref30-30] 30.0 ^30.1 Turnball F et al, for the Blood Pressure Lowering Treatment Trialists' Collaboration Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: Meta-analysis of randomised trials. BMJ 2008, 336:1121 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18480116

[ref31-31] 31.0 ^31.1 ^31.2 Krum H et al. Catheter-based renal sympathetic denervation for resistant hypertension: A multicentre safety and proof-of-principle cohort study. Lancet 2009 Mar 30; [e-pub ahead of print] <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19332353 <Internet> http://dx.doi.org/10.1016/S0140-6736(09)60566-3
Doumas M and Douma S. Interventional management of resistant hypertension. Lancet 2009 Mar 30; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19332354 <Internet> http://dx.doi.org/10.1016/S0140-6736(09)60624-3
Symplicity HTN-2 Investigators Renal sympathetic denervation in patients with treatment- resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 2010 Dec 4; 376:1903 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21093036 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62039-9/fulltext
Doumas M, Douma S. Renal sympathetic denervation: the jury is still out. Lancet 2010 Dec 4; 376:1878 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21093037
Brandt MC et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol 2012 Mar 6; 59:901. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22381425
Zile MR and Little WC. Effects of autonomic modulation: More than just blood pressure. J Am Coll Cardiol 2012 Mar 6; 59:910. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22381426
Krum H et al. Percutaneous renal denervation in patients with treatment- resistant hypertension: Final 3-year report of the Symplicity HTN-1 study. Lancet 2013 Nov 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24210779
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Meditronic News Release. Jan 9, 2014 Medtronic Announces U.S. Renal Denervation Pivotal Trial Fails to Meet Primary Efficacy Endpoint While Meeting Primary Safety Endpoint. http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=1889335&highlight=

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Use of blood pressure lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009 May 19; 338:b1665 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19454737 <Internet> http://dx.doi.org/10.1136/bmj.b1665

[ref33-33] Verdecchia P et al Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): An open-label randomised trial. Lancet 2009 Aug 15; 374:525. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19683638

[ref34-34] 34.0 ^34.1 Pimenta E et al Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: Results from a randomized trial. Hypertension 2009 Sep; 54:475 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19620517

[ref35-35] 35.0 ^35.1 Prescriber's Letter 16(12): 2009 Dosing Antihypertensive Meds in Kids CHART: Dosing Antihypertensive Meds in Kids GUIDELINES: Diagnosis and Treatment of Hypertension in Children and Adolescents (NIH) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=251211&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref36-36] 36.0 ^36.1 Chen L et al Reducing Consumption of Sugar-Sweetened Beverages Is Associated With Reduced Blood Pressure. A Prospective Study Among United States Adults Circulation. 2010, Published online May 24, 2010 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20497980 <Internet> http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.109.911164v1

[ref37-37] 37.0 ^37.1 ^37.2 ^37.3 McManus RJ et al, Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial The Lancet, Early Online Publication, 8 July 2010 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20619448 doi:10.1016/S0140-6736(10)60964-6 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60964-6/fulltext
Ogedegbe G Self-titration for treatment of uncomplicated hypertension The Lancet, Early Online Publication, 8 July 2010 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20619449 doi:10.1016/S0140-6736(10)61050-1 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61050-1/fulltext

[ref38-38] 38.0 ^38.1 ^38.2 ^38.3 Prescriber's Letter 17(10): 2010 COMMENTARY: Combination Therapy for Hypertension CHART: Antihypertensive Combinations PATIENT HANDOUT: Blood Pressure Medications and You PATIENT HANDOUT SPANISH VERSION: Sus Medicamentos Para La Presin Arterial GUIDELINES: Combination Therapy in Hypertension Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=261001&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref39-39] 39.0 ^39.1 ^39.2 ^39.3 ^39.4 Turner ST et al Plasma renin activity predicts blood pressure responses to beta-blocker and thiazide diuretic as monotherapy and add-on therapy for hypertension. Am J Hypertens 2010 Sep; 23:1014 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20725057
Alderman MH et al. Pressor responses to antihypertensive drug types. Am J Hypertens 2010 Sep; 23:1031 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20725055
Gupta AK et al on behalf of ASCOT investigators. Ethnic differences in blood pressure response to first and second-line antihypertensive therapies in patients randomized in the ASCOT trial. Am J Hypertens 2010 Sep; 23:1023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20725056
Brown MJ. Heterogeneity of blood pressure response to therapy. Am J Hypertens 2010 Sep; 23:926. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20733564
Furberg CD. Renin-guided treatment of hypertension: Time for action. Am J Hypertens 2010 Sep; 23:929. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20733565

[ref40-40] 40.0 ^40.1 ^40.2 ^40.3 Prescriber's Letter 17(12): 2010 COMMENTARY: Hypertension Treatment in African American Patients Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=261210&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref41-41] 41.0 ^41.1 Brown MJ et al Aliskiren and the calcium channel blocker amlodipine combination as an initial treatment strategy for hypertension control (ACCELERATE): a randomised, parallel-group trial Lancet. 2011 Jan 22;377(9762):312-20. Epub 2011 Jan 12. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21236483 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62003-X/fulltext

[ref42-42] 42.0 ^42.1 Houston TK et al Culturally appropriate storytelling to improve blood pressure: A randomized trial. Ann Intern Med 2011 Jan 18; 154:77. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21242364

[ref43-43] 43.0 ^43.1 Serumaga B et al. Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: Interrupted time series study. BMJ 2011 Jan 25; 342:d108 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21266440

[ref44-44] 44.0 ^44.1 Prescriber's Letter 18(3): 2011 COMMENTARY: Thiazides for Hypertension CHART: Comparison of Commonly Used Diuretics Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270304&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref45-45] Aronow WS et al, ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents J Am Coll Cardiol. 2011 Apr 15. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21524875 <Internet> http://content.onlinejacc.org/cgi/reprint/j.jacc.2011.01.008v1.pdf

[ref46-46] 46.0 ^46.1 ^46.2 Powers BJ et al Measuring Blood Pressure for Decision Making and Quality Reporting: Where and How Many Measures? Annals of Internal Medicine: June 20, 2011 154(12):781-788 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21690592 <Internet> http://www.annals.org/content/154/12/781.full.pdf+html
Appel LJ et al Improving the Measurement of Blood Pressure: Is It Time for Regulated Standards? Annals of Internal Medicine: June 20, 2011 154(12):838-39 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21690599 <Internet> http://www.annals.org/content/154/12/838.extract

[ref47-47] 47.0 ^47.1 Rosenfeldt F et al Systematic review of effect of coenzyme Q10 in physical exercise, hypertension and heart failure. Biofactors. 2003;18(1-4):91-100. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14695924

[ref48-48] 48.0 ^48.1 ^48.2 ^48.3 ^48.4 ^48.5 ^48.6 ^48.7 ^48.8 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019

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[ref50-50] 50.0 ^50.1 Knutson KL et al Association Between Sleep and Blood Pressure in Midlife The CARDIA Sleep Study Arch Intern Med. 2009;169(11):1055-1061 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19506175

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[ref52-52] 52.0 ^52.1 Diao D et al Pharmacotherapy for mild hypertension (Review) The Cochrane Library, 2012, issue 8 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22895954 <Internet> http://www.thecochranelibrary.com/details/file/2486291/CD006742.html
National Institutes of Health National Heart, Lung, and Blood Institute The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure NIH Publication No. 04-5230, August 2004 http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf

[ref53-53] 53.0 ^53.1 Weber MA et al Effects of body size and hypertension treatments on cardiovascular event rates: subanalysis of the ACCOMPLISH randomised controlled trial. The Lancet, Early Online Publication, 6 December 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23219284 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61343-9/abstract

[ref54-54] 54.0 ^54.1 Hajjar I et al Effect of antihypertensive therapy on cognitive function in early executive cognitive impairment: a double-blind randomized clinical trial. Arch Intern Med. 2012 Mar 12;172(5):442-4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22412114

[ref55-55] 55.0 ^55.1 Delgado J, Jacobs EA, Lackland DT, et al. Differences in blood pressure control in a large population- based sample of older African Americans and non-Hispanic whites. J Gerontol A Biol Sci Med Sci. 2012 Nov;67(11):1253-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22496537

[ref56-56] Choi HK, Soriano LC, Zhang Y, Rodriguez LA. Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study. BMJ 2012; 344:d8190 PMID: https://www.ncbi.nlm.nih.gov/pubmed/2224011

[ref57-57] 57.0 ^57.1 ^57.2 Ogawa H et al. Angiotensin II receptor blocker-based therapy in Japanese elderly, high-risk, hypertensive patients. Am J Med 2012 Oct; 125:981. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22503610
Kim-Mitsuyama S et al. An angiotensin II receptor blocker-calcium channel blocker combination prevents cardiovascular events in elderly high-risk hypertensive patients with chronic kidney disease better than high-dose angiotensin II receptor blocker alone. Kidney Int 2013 Jan; 83:167. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23051740

[ref58-58] 58.0 ^58.1 Weber MA et al. Effects of body size and hypertension treatments on cardiovascular event rates: Subanalysis of the ACCOMPLISH randomised controlled trial. Lancet 2013 Feb 16; 381:537 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23219284
Messerli FH and Bangalore S. Diuretic-based regimens for obese patients? Lancet 2013 Feb 16; 381:512. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23219285

[ref59-59] Prescriber's Letter 20(4): 2013 Evidence-Based Strategies for Managing Hypertension and Dyslipidemia. Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=290421&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref60-60] 60.0 ^60.1 Aburto NJ et al. Effect of increased potassium intake on cardiovascular risk factors and disease: Systematic review and meta-analyses. BMJ 2013 Apr 4; 346:f1378. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23558164

[ref61-61] Rosendorff C, Black HR, Cannon CP et al Treatment of hypertension in the prevention and management of ischemic heart disease: a scientific statement from the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention. Circulation. 2007 May 29;115(21):2761-88 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17502569

[ref62-62] American College of Physicians. In the clinic. Hypertension. Ann Intern Med. 2008 Dec 2;149(11):ITC6(1-15). PMID: https://www.ncbi.nlm.nih.gov/pubmed/19047024

[ref63-63] Sarafidis PA, Bakris GL. Resistant hypertension: an overview of evaluation and treatment. J Am Coll Cardiol. 2008 Nov 25;52(22):1749-57. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19022154

[ref64-64] 64.0 ^64.1 McKinstry B et al. Telemonitoring based service redesign for the management of uncontrolled hypertension: Multicentre randomised controlled trial. BMJ 2013 May 24; 346:f3030 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23709583

[ref65-65] Ernst ME, Gordon JA. Diuretic therapy: key aspects in hypertension and renal disease. J Nephrol. 2010 Sep-Oct;23(5):487-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20677164

[ref66-66] 66.0 ^66.1 Flack JM, Sica DA, Bakris G, Brown AL et al Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. 2010 Nov;56(5):780-800 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20921433

[ref67-67] Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010 May 26;303(20):2043-50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20501926

[ref68-68] 68.0 ^68.1 Bakris GL, Sarafidis PA, Weir MR et al Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial. Lancet. 2010 Apr 3;375(9721):1173-81. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20170948

[ref69-69] 69.0 ^69.1 Herttua K et al Adherence to antihypertensive therapy prior to the first presentation of stroke in hypertensive adults: population- based study. Eur Heart J. July 16, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23861328 <Internet> http://eurheartj.oxfordjournals.org/content/early/2013/07/09/eurheartj.eht219.abstract

[ref70-70] Mancia G et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013 Jun 14 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23771844 <Internet> http://eurheartj.oxfordjournals.org/content/34/28/2159

[ref71-71] 71.0 ^71.1 ^71.2 Jaffe MG et al Improved Blood Pressure Control Associated With a Large-Scale Hypertension Program. JAMA. 2013;310(7):699-705 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23989679 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1730511
Goyal A and Bornstein WA Health System - Wide Quality Programs to Improve Blood Pressure Control. JAMA. 2013;310(7):695-696 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23989806 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1730495

[ref72-72] 72.0 ^72.1 ^72.2 ^72.3 Sabayan B et al. Association of visit-to-visit variability in blood pressure with cognitive function in old age: Prospective cohort study. BMJ 2013 Jul 30; 347:f4600 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23900315 <Internet> http://www.bmj.com/content/347/bmj.f4600?ijkey=0bd340e53dee6e98694626975fbf9f474815ce8a&keytype2=tf_ipsecsha
Webb AJS Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. The Lancet. 2010 375:906-915 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20226989 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60235-8/fulltext

[ref73-73] 73.0 ^73.1 Go AS et al An effective Approach to High Blood Pressure Control A Science Advisory From the American Heart Association, the American College of Cardiology and the Centers for Disease Control and Prevention. Hypertension. Nov 15, 2013 http://hyper.ahajournals.org/content/early/2013/11/14/HYP.0000000000000003

[ref74-74] 74.0 ^74.1 ^74.2 ^74.3 ^74.4 Medscape: Dec 18, 2013 JNC 8 at Last! Guidelines Ease Up on BP Thresholds, Drug Choices. http://www.medscape.com/viewarticle/817991
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Bauchner H et al Updated Guidelines for Management of High Blood Pressure Recommendations, Review, and Responsibility. JAMA. Published online December 18, 2013. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24352759 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1791423
Peterson ED et al Recommendations for Treating Hypertension. What Are the Right Goals and Purposes? JAMA. Published online December 18, 2013. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24352710 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1791422
Sox HC Assessing the Trustworthiness of the Guideline for Management of High Blood Pressure in Adults. JAMA. Published online December 18, 2013. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24352688 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1791421

[ref75-75] 75.0 ^75.1 Greenhalgh J, Dickson R, Dundar Y. Biofeedback for hypertension: a systematic review. J Hypertens. 2010 Apr;28(4):644-52. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20090554

[ref76-76] Prescriber's Letter 21(3): 2014 Treatment of Hypertension: JNC 8 and More Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300317&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref77-77] Ritchie LD, Campbell NC, Murchie P. New NICE guidelines for hypertension. BMJ. 2011 Sep 7;343:d5644. doi:http://dx.doi.org/ 10.1136/bmj.d5644. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21900351

[ref78-78] 78.0 ^78.1 Kohler S et al. Temporal evolution of cognitive changes in incident hypertension: Prospective cohort study across the adult age span. Hypertension 2014 Feb; 63:245 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24296281 <Internet> http://hyper.ahajournals.org/content/63/2/245

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chronic hypertension

Contents

Classification

Etiology

Epidemiology

Pathology

Clinical manifestations

Laboratory

Diagnostic procedures

Radiology

Complications

Management

Notes

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chronic hypertension

Classification

Etiology

Epidemiology

Pathology

Clinical manifestations

Laboratory

Diagnostic procedures

Radiology

Complications

Management

Notes

More general terms

More specific terms

Additional terms

References

Patient information

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