Stage Stage 2 SBP mmHg | DBP mmHg | Management Normotensive | < 120 Prehypertensive | 120-129 - Lifestyle modification, routine follow-up 130-139 or - Lifestyle (all) - Pharm (for high risk individuals!) >1400r | >90 - Lifestyle + Pharm (for all) Severe > 180 - Management below Urgency SHigh Risk: CAD, HF, Diabetes, CKD, Age > 65 (controversial), ASCVD 10 year risk > 10% Hypertensive _ | - Severe grade hypertension with possible mild headache, but no end organ damage Hypertensive _ | - Severe grade hypertension with evidence of end organ damage, including: Emergency - CNS: Encephalopathy, stroke, elevated ICP, retinal hemorrhage - Renal: AKI, hematuria, proteinuria - Cardiovascular: ACS, angina, worsening CHE, dissection Secondary Hypertension | pheochromocytoma, Cushing's, aortic coarctation, meds (OCP), OSA White Coat - Elevated blood pressure in doctor's office Hypertension - Diagnose with either 24 hour ambulatory or home BP monitoring - Etiologies: CKD, renal arterial stenosis, hyperaldosteronism, - Workup for secondary hypertension indicated if: Young (age < 35), severely elevated BP, refractory BP, or sign specific to secondary disorder Risk: Family history, Black, high salt intake, alcohol use, obesity, physical inactivity Diagnosis: Two seperate clinic readings over 4 weeks - Ambulatory or home blood pressure monitoring preferred to confirm Management: Severe - Lifestyle Modification (in order of efficacy): Weight Loss > DASH Diet > Exercise > Salt Restriction > Alcohol Limitation - Pharm indicated if > 140/90 in average risk adult, or > 130/80 in high risk adult - First Line Meds: Include ACEi/ARB, thiazides, or Ca-Channel Blockers - Med choice should be tailored based on patient's comorbid conditions Overall goal for either is either 25% reduction from baseline or < 160/100 mmHg Emergency - Drop MAP by ~20% in first hour, with total of no more than 25% in 24 hrs - Overly aggressive reduction can lead to ischemic end organ damage (unable to autoregulate in time) - Drug Choice: IV Hydralazine, Esmolol, Nitroprusside, Labetalol, Nicardipine Urgency (Asymptomatic Severe Hypertension) - Lower within 24 hours using oral meds (Captopril, Clonidine, Labetalol, etc)