• Melissa Gunasekera
  • John D. Bisognano
  • G. Ronald Beck


With an estimated 50 million Americans diagnosed with hypertension, it is the most common medical condition in the United States. Patients with hypertension and no identifiable cause are said to have essential or primary hypertension, which is the type of hypertension for 90% of hypertensive patients. A number of factors have been implicated in the development of hypertension including dietary salt intake, obesity, alcohol intake, occupation, and stress. Patients with hypertension have an increased risk of developing a morbid cardiovascular event and will likely benefit from medical therapy. Their evaluation should be directed at identifying correctable forms of hypertension, the presence of target organ damage, and other risk factors for cardiovascular disease. Risk factors of an adverse prognosis in hypertension include male sex, smoking, diabetes mellitus, obesity, hypercholesterolemia, and African-American race. This chapter focuses on target blood pressure guidelines, lifestyle modifications, and the medical management of hypertension.


Common Adverse Effect Loop Diuretic Calcium Channel Antagonist Resistant Hypertension Target Organ Damage 
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Further Reading

  1. 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 developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. Aronow WS, et al. J Am Coll Cardiol. 2011 May 17;57(20)2037–114. Epub April 25, 2011.Google Scholar
  2. ALLHAT Collaborative Research Group. The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Major outcomes in high-risk hypertensive patients randomized to angiotensin converting enzyme inhibitor or calcium channel blockers vs. diuretic. JAMA. 2002;288:2981.CrossRefGoogle Scholar
  3. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887–98.PubMedCrossRefGoogle Scholar
  4. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VII). JAMA. 2003;289(6):2560–72.PubMedCrossRefGoogle Scholar
  5. Kaplan N. Systemic hypertension: mechanisms and diagnosis. In: Zipes D et al., editors. Braunwald’s heart disease. 7th ed. Philadelphia: Saunders; 2005.Google Scholar
  6. Pickering TG, Hall JE, Appel LJ, et al. Recommendations for BP measurement in humans and experimental animals; part 1: BP measurement in humans: a statement for professionals from the subcommittee of Professional and Public Education of the American Heart Association Council on High BP Research. Hypertension. 2005;45:142–61.PubMedGoogle Scholar
  7. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. N Engl J Med. 2001;344:3–10.PubMedCrossRefGoogle Scholar
  8. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA. 1991;265:3255–64.CrossRefGoogle Scholar
  9. Stampfer MJ, Hu FB, Manson JE, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343:16–22.PubMedCrossRefGoogle Scholar
  10. Wachtell K, Lehto M, Gerdts E, et al. Angiotensin II receptor blockade reduces new onset atrial-fibrillation and subsequent stroke compared to atenolol: the losartan intervention for end point reduction in hypertension (LIFE) study. J Am Coll Cardiol. 2005;45(5):712–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • Melissa Gunasekera
    • 1
  • John D. Bisognano
    • 2
  • G. Ronald Beck
    • 2
  1. 1.Department of MedicineUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Division of Cardiology, Department of Internal MedicineUniversity of Rochester Medical CenterRochesterUSA

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